Oliveira, C.
Barbosa, B.
Couto, J.G.
Bravo, I.
Khine, R.
McNair, H.
(2022). Advanced practice roles of therapeutic radiographers/radiation therapists: A systematic literature review. ,
Vol.28
(3),
pp. 605-619.
show abstract
INTRODUCTION: Advances in Radiotherapy (RT) technology and increase of complexity in cancer care have enabled the implementation of new treatment techniques. Subsequently, a greater level of autonomy, responsibility, and accountability in the practice of Therapeutic Radiographers/Radiation Therapists (TR/RTTs) has led to Advanced Practice (AP) roles. The published evidence of this role is scattered with confusing terminology and divergence regarding the perception of whether a specific role represents AP internationally. This study aims to establish an international baseline of evidence on AP roles in RT to identify roles and activities performed by TR/RTTs at advanced level practice and to summarise the impact. METHODS: A systematic PRISMA review of the literature was undertaken. Thematic analysis was used to synthesise the roles and associated activities. Six RT external experts validated the list. The impact was scrutinised in terms of clinical, organisational, and professional outcomes. RESULTS: Studies (n = 87) were included and categorised into four groups. AP roles were listed by clinical area, site-specific, and scope of practice, and advanced activities were organised into seven dimensions and 27 sub-dimensions. Three most-reported outcomes were: enhanced service capacity, higher patient satisfaction, and safety maintenance. CONCLUSION: Evidence-based AP amongst TR/RTTs show how AP roles were conceptualised, implemented, and evaluated. Congruence studies have shown that TR/RTTs are at par with the gold-standard across the various AP roles. IMPLICATIONS FOR PRACTICE: This is the first systematic literature review synthetisising AP roles and activities of TR/RTTs. This study also identified the main areas of AP that can be used to develop professional frameworks and education guiding policy by professional bodies, educators and other stakeholders..
Mitchell, A.
Ingle, M.
Smith, G.
Chick, J.
Diamantopoulos, S.
Goodwin, E.
Herbert, T.
Huddart, R.
McNair, H.
Oelfke, U.
Nill, S.
Dunlop, A.
Hafeez, S.
(2022). Feasibility of tumour-focused adaptive radiotherapy for bladder cancer on the MR-linac. ,
Vol.35,
pp. 27-32.
show abstract
Bladder tumour-focused magnetic resonance image-guided adaptive radiotherapy using a 1.5 Tesla MR-linac is feasible. A full online workflow adapting to anatomy at each fraction is achievable in approximately 30 min. Intra-fraction bladder filling did not compromise target coverage with the class solution employed..
Joyce, E.
Jackson, M.
Skok, J.
Peet, B.
McNair, H.A.
(2022). Images and images: Current roles of therapeutic radiographers. ,
Vol.28
(4),
pp. 1093-1100.
show abstract
INTRODUCTION: Therapeutic radiography is a small profession and has adapted in response to advanced techniques. An increase in on-line adaptive MRI-guided radiotherapy (MRIgRT) will require role extension for therapeutic radiographers (TRs). This study will investigate the current role description for TRs and the activities they currently undertake with regards to MRIgRT. METHOD: A training needs analysis was used to ask TRs about their current roles and responsibilities and essential skills required for MRIgRT. For the purposes of this paper, the authors present the results from the demographics of the individual, their current job title with roles and responsibilities, and experience with decision making and image assessment. Descriptive statistics was used to analyse the data. RESULTS: 261 responses were received (n = 261). Only 28% of job titles listed contained the protected title of 'therapeutic radiographer'. Advanced clinical practice roles were expressed by participants indicating that if a service need is presented, emerging roles will be created. Variation existed across the standardised roles of TRs and this discrepancy could present challenges when training for MRIgRT. TRs are pivotal in image verification and recognition on a standard linac, and skills developed there can be transferred to MRIgRT. Decision making is crucial for adaptive techniques and there are many skills within their current scope of practice that are indispensable for the MRIgRT. CONCLUSION: It has been demonstrated that TRs have a range of roles that cover vast areas of the oncology pathway and so it is important that TRs are recognised so the pivotal role they play is understood by all. TRs have extensive soft-tissue IGRT knowledge and experience, aiding the evolution of decision-making skills and application of off-protocol judgments, the basis of MRIgRT. IMPLICATIONS FOR PRACTICE: Role development and changes in education for therapeutic radiographers..
McNair, H.A.
Franks, K.N.
van Herk, M.
(2022). On Target 2: Updated Guidance for Image-guided Radiotherapy. Clinical oncology,
Vol.34
(3),
pp. 187-188.
Hall, H.
Dhuga, Y.
Yan Zheng, C.
Clunie, G.
Joyce, E.
McNair, H.
McGregor, A.H.
(2022). Patient and practitioner perspectives on the design of a simulated affective touch device to reduce procedural anxiety associated with radiotherapy: a qualitative study. Bmj open,
Vol.12
(3),
pp. e050288-e050288.
show abstract
ObjectiveThe aim of this study was to elicit the views of relevant stakeholders on the design of a device using simulated affective touch to reduce procedural anxiety surrounding radiotherapy and imaging.DesignThis qualitative study collected data from focus groups which were then analysed using inductive thematic analysis in line with Braun and Clarke’s methods.Participants and settingTwenty patients and carers were recruited, as well as 10 healthcare practitioners involved in either delivering radiotherapy or imaging procedures.ResultsPatients, carers and healthcare practitioners agreed on some aspects of the device design, such as ensuring the device is warm and flexible in where it can be used on the body. However, patient and healthcare practitioner cohorts had at times differing viewpoints. For example, healthcare practitioners provided professional perspectives and required easy cleaning of the device. Meanwhile patients focused on anxiety-relieving factors, such as the tactile sensation of the device being either a vibration or pulsation. There was no consensus on who should control the device.ConclusionsThe desired features of a simulated affective touch device have been investigated. Different priorities of patients and their carers and healthcare practitioners were evident. Any design must incorporate such features as to appease both groups. Areas where no consensus was reached could be further explored, alongside including further patient and public involvement in the form of a project advisory group..
Gimson, E.
Greca Dottori, M.
Clunie, G.
Yan Zheng, C.
Wiseman, T.
Joyce, E.
McGregor, A.
McNair, H.
(2022). Not as simple as "fear of the unknown": A qualitative study exploring anxiety in the radiotherapy department. ,
Vol.31
(2),
p. e13564.
show abstract
OBJECTIVE: Little is understood about the anxiety experienced by cancer patients undergoing radiotherapy or investigative imaging. Our aim was to identify sources of anxiety, the points along the cancer journey where anxiety occurred and methods to alleviate it. METHODS: Six focus groups were conducted with cancer patients (n = 17), caregivers (n = 3) and healthcare practitioners (HCPs; n = 10) in the radiotherapy department. Patients described specific elements in the care pathway which induced anxiety, while HCPs focused on their perception of the patient experience. Thematic analysis was used to analyse data. RESULTS: Three broad themes emerged: The Environment, The Individual and The Unknown. The physical environment of the hospital, inside the scanner for example, emerged as a key source of anxiety. The impact of cancer on patients' individual lives was significant, with many feeling isolated. The majority of participants described anxiety associated with the unknown. HCPs reported difficulty in identifying the anxious patient. CONCLUSIONS: Anxiety is experienced throughout the cancer pathway. Common sources include the physical environment and the uncertainty associated with having cancer. Identifying both anxiety-inducing factors, and the anxious patients themselves, is crucial to enable targeted interventions to alleviate anxiety..
Adair Smith, G.
McNair, H.A.
Barnes, H.
(2021). An environmentally friendly alternative to single-use plastics for radiotherapy bladder preparation. ,
Vol.18,
pp. 29-31.
show abstract
More than 60,000 plastic cups were used annually for bladder preparation in one radiotherapy centre. As an alternative, patients were provided with a specifically designed reusable water bottle, aiming to reduce waste and improve bladder filling compliance. Cup usage and bladder volume at treatment were calculated pre- and post-implementation. Bladder volume was measured as a percentage of the planned volume and grouped for analysis. Cup usage halved from 12,000 cups to 6000 cups. Percentage of bladder volumes in the optimal group increased from 47% to 54%. The introduction of water bottles reduced plastic cup usage and increased bladder filling compliance..
Lawes, R.
Carter, E.
Hussein, M.
Murray, J.
McNair, H.A.
(2021). Retrospective audit of inter-fraction motion for pelvic node radiotherapy in prostate cancer patients. Radiography,
Vol.27
(2),
pp. 266-271.
Simcock, I.C.
Reeve, R.
Burnett, C.
Costigan, C.
McNair, H.
Robinson, C.
Arthurs, O.J.
(2021). Clinical academic radiographers – A challenging but rewarding career. Radiography,
Vol.27,
pp. S14-S19.
McNair, H.A.
Joyce, E.
O'Gara, G.
Jackson, M.
Peet, B.
Huddart, R.A.
Wiseman, T.
(2021). Radiographer-led online image guided adaptive radiotherapy: A qualitative investigation of the therapeutic radiographer role. Radiography (lond),
.
show abstract
INTRODUCTION: Online MRI guided adaptive radiotherapy (MRIgRT) is resource intensive. To maintain and increase uptake traditional roles and responsibilities may need refining. This novel study aims to provide an in-depth understanding and subsequent impact of the roles required to deliver on-line adaptive MRIgRT by exploring the current skills and knowledge of radiographers. METHOD: A purposive sampling approach was used to invite radiographers, clinicians and physicists from centres with experience of MRIgRT to participate. Focus Group Interviews were conducted with two facilitators using a semi-structure interview guide (Appendix 1). Four researchers independently familiarised themselves and coded the data using framework analysis. A consensus thematic framework of ptive Radiotherapy codes and categories was agreed and systematically applied. RESULTS: Thirty participants took part (Radiographers: N = 18, Physicists: N = 9 and Clinicians: N = 3). Three key themes were identified: 'Current MRIgRT', 'Training' and 'Future Practice'. Current MRIgRT identified a variation in radiographers' roles and responsibilities with pathways ranging from radiographer-led, clinician-light-led and MDT-led. The consensus was to move towards radiographer-led with the need to have a robust on-call service heavily emphasised. Training highlighted the breadth of knowledge required by radiographers including MRI, contouring, planning and dosimetry, and treatment experience. Debate was presented over timing and length of training required. Future Practice identified the need to have radiographers solely deliver MRIgRT, to reduce staff present which was seen as a main driver, and time and resources to train radiographers seen as the main barriers. CONCLUSION: Radiographer-led MRIgRT is an exciting development because of the potential radiographer role development. A national training framework created collaboratively with all stakeholders and professions involved would ensure consistency in skills and knowledge. IMPLICATIONS FOR PRACTICE: Role development and changes in education for therapeutic radiographers..
Cuccia, F.
Alongi, F.
Belka, C.
Boldrini, L.
Hörner-Rieber, J.
McNair, H.
Rigo, M.
Schoenmakers, M.
Niyazi, M.
Slagter, J.
Votta, C.
Corradini, S.
(2021). Patient positioning and immobilization procedures for hybrid MR-Linac systems. Radiation oncology (london, england),
Vol.16
(1),
pp. 183-?.
show abstract
Hybrid magnetic resonance (MR)-guided linear accelerators represent a new horizon in the field of radiation oncology. By harnessing the favorable combination of on-board MR-imaging with the possibility to daily recalculate the treatment plan based on real-time anatomy, the accuracy in target and organs-at-risk identification is expected to be improved, with the aim to provide the best tailored treatment. To date, two main MR-linac hybrid machines are available, Elekta Unity and Viewray MRIdian. Of note, compared to conventional linacs, these devices raise practical issues due to the positioning phase for the need to include the coil in the immobilization procedure and in order to perform the best reproducible positioning, also in light of the potentially longer treatment time. Given the relative novelty of this technology, there are few literature data regarding the procedures and the workflows for patient positioning and immobilization for MR-guided daily adaptive radiotherapy. In the present narrative review, we resume the currently available literature and provide an overview of the positioning and setup procedures for all the anatomical districts for hybrid MR-linac systems..
Webster, A.
Hafeez, S.
Lewis, R.
Griffins, C.
Warren-Oseni, K.
Patel, E.
Hansen, V.N.
Hall, E.
Huddart, R.
Miles, E.
McNair, H.A.
(2021). The Development of Therapeutic Radiographers in Imaging and Adaptive Radiotherapy Through Clinical Trial Quality Assurance. Clinical oncology (royal college of radiologists (great britain)),
.
show abstract
Aims Adaptive radiotherapy (ART) is an emerging advanced treatment option for bladder cancer patients. Therapeutic radiographers (RTTs) are central to the successful delivery of this treatment. The purpose of this work was to evaluate the image-guided radiotherapy (IGRT) and ART experience of RTTs before participating in the RAIDER trial. A plan of the day (PoD) quality assurance programme was then implemented. Finally, the post-trial experience of RTTs was evaluated, together with the impact of trial quality assurance participation on their routine practice.Materials and methods A pre-trial questionnaire to assess the experience of the RTT staff group in IGRT and ART in bladder cancer was sent to each centre. Responses were grouped according to experience. The PoD quality assurance programme was implemented, and the RAIDER trial commenced. During stage 1 of the trial, RTTs reported difficulties in delivering PoD and the quality assurance programme was updated accordingly. A follow-up questionnaire was sent assessing experience in IGRT and ART post-trial. Any changes in routine practice were also recorded.Results The experience of RTTs in IGRT and ART pre-trial varied. For centres deemed to have RTTs with more experience, the initial PoD quality assurance programme was streamlined. For RTTs without ART experience, the full quality assurance programme was implemented, of which 508 RTTs completed. The quality assurance programme was updated (as the trial recruited) and it was mandated that at least one representative RTT (regardless of pre-trial experience) participated in the update in real-time. The purpose of the updated quality assurance programme was to provide further support to RTTs in delivering a complex treatment. Engagement with the updated quality assurance programme was high, with RTTs in 24/33 centres participating in the real-time online workshop. All 33 UK centres reported all RTTs reviewed the updated training offline. Post-trial, the RTTs' experience in IGRT and ART was increased.Conclusion Overall, 508 RTTs undertook the PoD quality assurance programme. There was a high engagement of RTTs in the PoD quality assurance programme and trial. RTTs increased their experience in IGRT and ART and subsequently updated their practice for bladder cancer and other treatment sites..
Corradini, S.
Alongi, F.
Andratschke, N.
Azria, D.
Bohoudi, O.
Boldrini, L.
Bruynzeel, A.
Hörner-Rieber, J.
Jürgenliemk-Schulz, I.
Lagerwaard, F.
McNair, H.
Raaymakers, B.
Schytte, T.
Tree, A.
Valentini, V.
Wilke, L.
Zips, D.
Belka, C.
(2021). ESTRO-ACROP recommendations on the clinical implementation of hybrid MR-linac systems in radiation oncology. Radiotherapy and oncology : journal of the european society for therapeutic radiology and oncology,
Vol.159,
pp. 146-154.
show abstract
Online magnetic resonance-guided radiotherapy (oMRgRT) represents one of the most innovative applications of current image-guided radiation therapy (IGRT). The revolutionary concept of oMRgRT systems is the ability to acquire MR images for adaptive treatment planning and also online imaging during treatment delivery. The daily adaptive planning strategies allow to improve targeting accuracy while avoiding critical structures. This ESTRO-ACROP recommendation aims to provide an overview of available systems and guidance for best practice in the implementation phase of hybrid MR-linac systems. Unlike the implementation of other radiotherapy techniques, oMRgRT adds the MR environment to the daily practice of radiotherapy, which might be a new experience for many centers. New issues and challenges that need to be thoroughly explored before starting clinical treatments will be highlighted..
Townend, C.
Landeg, S.
Thorne, R.
Kirby, A.M.
McNair, H.A.
(2020). A review of permanent marking for radiotherapy in the UK. Radiography,
Vol.26
(1),
pp. 9-14.
Tan, M.P.
Harris, V.
Warren-Oseni, K.
McDonald, F.
McNair, H.
Taylor, H.
Hansen, V.
Sharabiani, M.
Thomas, K.
Jones, K.
Dearnaley, D.
Hafeez, S.
Huddart, R.A.
(2020). The Intensity-Modulated Pelvic Node and Bladder Radiotherapy (IMPART) Trial: A Phase II Single-Centre Prospective Study. Clinical oncology (royal college of radiologists (great britain)),
Vol.32
(2),
pp. 93-100.
show abstract
Aims Node-positive bladder cancer (NPBC) carries a poor prognosis and has traditionally been treated palliatively. However, surgical series suggest that a subset of NPBC patients can achieve long-term control after cystectomy and lymph node dissection. There is little published data regarding the use of radiotherapy to treat NPBC patients. This is in part due to concerns regarding the toxicity of whole-pelvis radiotherapy using conventional techniques. We hypothesised that, using intensity-modulated radiotherapy (IMRT), the pelvic nodes and bladder could be treated within a radical treatment volume with acceptable toxicity profiles.Materials and methods The Intensity-modulated Pelvic Node and Bladder Radiotherapy (IMPART) trial was a phase II single-centre prospective study designed to assess the feasibility of delivering IMRT to treat the bladder and pelvic nodes in patients with node-positive or high-risk node-negative bladder cancer (NNBC). The primary end point was meeting predetermined dose constraints. Secondary end points included acute and late toxicity, pelvic relapse-free survival and overall survival.Results In total, 38 patients were recruited and treated between June 2009 and November 2012; 22/38 (58%) had NPBC; 31/38 (81.6%) received neoadjuvant chemotherapy; 18/38 (47%) received concurrent chemotherapy; 37/38 (97%) patients had radiotherapy planned as per protocol. Grade 3 gastrointestinal and genitourinary acute toxicity rates were 5.4 and 20.6%, respectively. At 1 year, the grade 3 late toxicity rate was 5%; 1-, 2- and 5-year pelvic relapse-free survival rates were 55, 37 and 26%, respectively. The median overall survival was 1.9 years (95% confidence interval 1.1-3.8) with 1-, 2- and 5-year overall survival rates of 68, 50 and 34%, respectively.Conclusion Delivering IMRT to the bladder and pelvic nodes in NPBC and high-risk NNBC is feasible, with low toxicity and low pelvic nodal recurrence rates. Long-term control seems to be achievable in a subset of patients. However, relapse patterns suggest that strategies targeting both local recurrence and the development of distant metastases are required to improve patient outcomes..
Murray, J.R.
Tree, A.C.
Alexander, E.J.
Sohaib, A.
Hazell, S.
Thomas, K.
Gunapala, R.
Parker, C.C.
Huddart, R.A.
Gao, A.
Truelove, L.
McNair, H.A.
Blasiak-Wal, I.
deSouza, N.M.
Dearnaley, D.
(2020). Standard and Hypofractionated Dose Escalation to Intraprostatic Tumor Nodules in Localized Prostate Cancer: Efficacy and Toxicity in the DELINEATE Trial. International journal of radiation oncology, biology, physics,
Vol.106
(4),
pp. 715-724.
show abstract
Purpose To report a planned analysis of the efficacy and toxicity of dose escalation to the intraprostatic dominant nodule identified on multiparametric magnetic resonance imaging using standard and hypofractionated external beam radiation therapy.Methods and materials DELINEATE is a single centre prospective phase 2 multicohort study including standard (cohort A: 74 Gy in 37 fractions) and moderately hypofractionated (cohort B: 60 Gy in 20 fractions) prostate image guided intensity modulated radiation therapy in patients with National Comprehensive Cancer Network intermediate- and high-risk disease. Patients received an integrated boost of 82 Gy (cohort A) and 67 Gy (cohort B) to lesions visible on multiparametric magnetic resonance imaging. Fifty-five patients were treated in cohort A, and 158 patients were treated in cohort B; the first 50 sequentially treated patients in cohort B were included in this planned analysis. The primary endpoint was late Radiation Therapy Oncology Group rectal toxicity at 1 year. Secondary endpoints included acute and late toxicity measured with clinician- and patient-reported outcomes at other time points and biochemical relapse-free survival for cohort A. Median follow-up was 74.5 months for cohort A and 52.0 months for cohort B.Results In cohorts A and B, 27% and 40% of patients, respectively, were classified as having National Comprehensive Cancer Network high-risk disease. The cumulative 1-year incidence of Radiation Therapy Oncology Group grade 2 or worse rectal and urinary toxicity was 3.6% and 0% in cohort A and 8% and 10% in cohort B, respectively. There was no reported late grade 3 rectal toxicity in either cohort. Within cohort A, 4 of 55 (7%) patients had biochemical relapse.Conclusions Delivery of a simultaneous integrated boost to intraprostatic dominant nodules is feasible in prostate radiation therapy using standard and moderately hypofractionated regimens, with rectal and genitourinary toxicity comparable to contemporary series without an intraprostatic boost..
Barnes, H.
Mohajer, J.
Dunlop, A.
Adair Smith, G.
Herbert, T.
Lawes, R.
Tree, A.
McNair, H.
(2020). Laser-free pelvic alignment in an online adaptive radiotherapy environment. Technical innovations & patient support in radiation oncology,
Vol.13,
pp. 21-23.
show abstract
The MR-Linac (MRL) provides a novel treatment modality that enables online adaptive treatments, but also creates new challenges for patient positioning in a laser-free environment. The accuracy and duration of prostate patient set-up on the MRL using two different methods for patient alignment was determined to establish standard of practice on the MRL. Differences in set-up accuracy were significant in the longitudinal direction and are accounted for in online plan adaption. Both methods recorded similar set-up times. The vendor recommended alignment method involves less manipulation of the patient and will be adopted as the standard positioning method for prostate and other pelvic patients on the MRL in future..
Dunlop, A.
Mitchell, A.
Tree, A.
Barnes, H.
Bower, L.
Chick, J.
Goodwin, E.
Herbert, T.
Lawes, R.
McNair, H.
McQuaid, D.
Mohajer, J.
Nilawar, R.
Pathmanathan, A.
Smith, G.
Hanson, I.
Nill, S.
Oelfke, U.
(2020). Daily adaptive radiotherapy for patients with prostate cancer using a high field MR-linac: Initial clinical experiences and assessment of delivered doses compared to a C-arm linac. Clinical and translational radiation oncology,
Vol.23,
pp. 35-42.
show abstract
Introduction:MR-guided adapted radiotherapy (MRgART) using a high field MR-linac has recently become available. We report the estimated delivered fractional dose of the first five prostate cancer patients treated at our centre using MRgART and compare this to C-Arm linac daily Image Guided Radiotherapy (IGRT). Methods:Patients were treated using adapted treatment plans shaped to their daily anatomy. The treatments were recalculated on an MR image acquired immediately prior to treatment delivery in order to estimate the delivered fractional dose. C-arm linac non-adapted VMAT treatment plans were recalculated on the same MR images to estimate the fractional dose that would have been delivered using conventional radiotherapy techniques using a daily IGRT protocol. Results:95% and 93% of mandatory target coverage objectives and organ at risk dose constraints were achieved by MRgART and C-arm linac delivered dose estimates, respectively. Both delivery techniques were estimated to have achieved 98% of mandatory Organ At Risk (OAR) dose constraints whereas for the target clinical goals, 86% and 80% were achieved by MRgART and C-arm linac delivered dose estimates. Conclusions:Prostate MRgART can be delivered using the a high field MR-linac. Radiotherapy performed on a C-arm linac offers a good solution for prostate cancer patients who present with favourable anatomy at the time of reference imaging and demonstrate stable anatomy throughout the course of their treatment. For patients with critical OARs abutting target volumes on their reference image we have demonstrated the potential for a target dose coverage improvement for MRgART compared to C-arm linac treatment..
Grimwood, A.
Rivaz, H.
Zhou, H.
McNair, H.A.
Jakubowski, K.
Bamber, J.C.
Tree, A.C.
Harris, E.J.
(2020). Improving 3D ultrasound prostate localisation in radiotherapy through increased automation of interfraction matching. Radiotherapy and oncology : journal of the european society for therapeutic radiology and oncology,
Vol.149,
pp. 134-141.
show abstract
Background and purpose Daily image guidance is standard care for prostate radiotherapy. Innovations which improve the accuracy and efficiency of ultrasound guidance are needed, particularly with respect to reducing interobserver variation. This study explores automation tools for this purpose, demonstrated on the Elekta Clarity Autoscan®. The study was conducted as part of the Clarity-Pro trial (NCT02388308). Materials and methods Ultrasound scan volumes were collected from 32 patients. Prostate matches were performed using two proposed workflows and the results compared with Clarity's proprietary software. Gold standard matches derived from manually localised landmarks provided a reference. The two workflows incorporated a custom 3D image registration algorithm, which was benchmarked against a third-party application (Elastix). Results Significant reductions in match errors were reported from both workflows compared to standard protocol. Median (IQR) absolute errors in the left-right, anteroposterior and craniocaudal axes were lowest for the Manually Initiated workflow: 0.7(1.0) mm, 0.7(0.9) mm, 0.6(0.9) mm compared to 1.0(1.7) mm, 0.9(1.4) mm, 0.9(1.2) mm for Clarity. Median interobserver variation was ≪0.01 mm in all axes for both workflows compared to 2.2 mm, 1.7 mm, 1.5 mm for Clarity in left-right, anteroposterior and craniocaudal axes. Mean matching times was also reduced to 43 s from 152 s for Clarity. Inexperienced users of the proposed workflows attained better match precision than experienced users on Clarity. Conclusion Automated image registration with effective input and verification steps should increase the efficacy of interfraction ultrasound guidance compared to the current commercially available tools..
Huddart, R.
Hafeez, S.
Lewis, R.
McNair, H.
Syndikus, I.
Henry, A.
Staffurth, J.
Dewan, M.
Vassallo-Bonner, C.
Moinuddin, S.A.
Birtle, A.
Horan, G.
Rimmer, Y.
Venkitaraman, R.
Khoo, V.
Mitra, A.
Hughes, S.
Gibbs, S.
Kapur, G.
Baker, A.
Hansen, V.N.
Patel, E.
Hall, E.
HYBRID Investigators,
(2020). Clinical Outcomes of a Randomized Trial of Adaptive Plan-of-the-Day Treatment in Patients Receiving Ultra-hypofractionated Weekly Radiation Therapy for Bladder Cancer. International journal of radiation oncology, biology, physics,
.
show abstract
Purpose Hypofractionated radiation therapy can be used to treat patients with muscle-invasive bladder cancer unable to have radical therapy. Toxicity is a key concern, but adaptive plan-of the day (POD) image-guided radiation therapy delivery could improve outcomes by minimizing the volume of normal tissue irradiated. The HYBRID trial assessed the multicenter implementation, safety, and efficacy of this strategy.Methods HYBRID is a Phase II randomized trial that was conducted at 14 UK hospitals. Patients with T2-T4aN0M0 muscle-invasive bladder cancer unsuitable for radical therapy received 36 Gy in 6 weekly fractions, randomized (1:1) to standard planning (SP) or adaptive planning (AP) using a minimization algorithm. For AP, a pretreatment cone beam computed tomography (CT) was used to select the POD from 3 plans (small, medium, and large). Follow-up included standard cystoscopic, radiologic, and clinical assessments. The primary endpoint was nongenitourinary Common Terminology Criteria for Adverse Events (CTCAE) grade ≥ 3 (≥G3) toxicity within 3 months of radiation therapy. A noncomparative single stage design aimed to exclude ≥30% toxicity rate in each planning group in patients who received ≥1 fraction of radiation therapy. Local control at 3-months (both groups combined) was a key secondary endpoint.Results Between April 15, 2014, and August 10, 2016, 65 patients were enrolled (SP, n = 32; AP, n = 33). The median follow-up time was 38.8 months (interquartile range [IQR], 36.8-51.3). The median age was 85 years (IQR, 81-89); 68% of participants (44 of 65) were male; and 98% of participants had grade 3 urothelial cancer. In 63 evaluable participants, CTCAE ≥G3 nongenitourinary toxicity rates were 6% (2 of 33; 95% confidence interval [CI], 0.7%-20.2%) for the AP group and 13% (4 of 30; 95% CI, 3.8%-30.7%) for the SP group. Disease was present in 9/48 participants assessed at 3 months, giving a local control rate of 81.3% (95% CI, 67.4%-91.1%).Conclusions POD adaptive radiation therapy was successfully implemented across multiple centers. Weekly ultrahypofractionated 36 Gy/6 fraction radiation therapy is safe and provides good local control rates in this older patient population..
Goldsworthy, S.
Palmer, S.
Latour, J.M.
McNair, H.
Cramp, M.
(2020). A systematic review of effectiveness of interventions applicable to radiotherapy that are administered to improve patient comfort, increase patient compliance, and reduce patient distress or anxiety. Radiography,
Vol.26
(4),
pp. 314-324.
Hunt, A.
Hanson, I.
Dunlop, A.
Barnes, H.
Bower, L.
Chick, J.
Cruickshank, C.
Hall, E.
Herbert, T.
Lawes, R.
McQuaid, D.
McNair, H.
Mitchell, A.
Mohajer, J.
Morgan, T.
Oelfke, U.
Smith, G.
Nill, S.
Huddart, R.
Hafeez, S.
(2020). Feasibility of magnetic resonance guided radiotherapy for the treatment of bladder cancer. Clinical and translational radiation oncology,
Vol.25,
pp. 46-51.
show abstract
Whole bladder magnetic resonance image-guided radiotherapy using the 1.5 Telsa MR-linac is feasible. Full online adaptive planning workflow based on the anatomy seen at each fraction was performed. This was delivered within 45 min. Intra-fraction bladder filling did not compromise target coverage. Patients reported acceptable tolerance of treatment..
Goldsworthy, S.
Zheng, C.Y.
McNair, H.
McGregor, A.
(2020). The potential for haptic touch technology to supplement human empathetic touch during radiotherapy. Journal of medical imaging and radiation sciences,
Vol.51
(4),
pp. S39-S43.
McNair, H.A.
Wiseman, T.
Joyce, E.
Peet, B.
Huddart, R.A.
(2020). International survey; current practice in On-line adaptive radiotherapy (ART) delivered using Magnetic Resonance Image (MRI) guidance. Technical innovations & patient support in radiation oncology,
Vol.16,
pp. 1-9.
show abstract
Background and purpose The uptake of new technologies has varied internationally and there have often been barriers to implementation. On-line adaptive radiotherapy (ART) promises to improve patient outcome. This survey focuses on the implementation phase of delivering ART and professional roles and responsibilities currently involved in the workflow and changes which may be expected in the future.Materials and methods A 38 question survey included aspects on current practice; professional responsibilities; benefits and barriers; and decision making and responsibilities. For the purposes of the questionnaire and paper, ART was considered where tumour and /or organs at risk were contoured and re-planning was performed on-line. The questionnaire was electronically distributed via radiotherapy networks.Results Nineteen international responses were received. Europe (n = 11), United States of America (n = 4); Canada (n = 2), Australia (n = 1) and Hong Kong (n = 1). The majority of centres started using ART in either 2018 (n = 7) or 2019 (n = 6). Four centres started treating with ART between 2015 and 2017, and the first was in 2014. Centres initially treated prostate and oligometastases patients, expanding to treat prostate, oligometastases, pancreas and rectum. The majority of centres were working in conventional roles, however moving towards radiographers taking more responsibility in contouring organs at risk (OAR), target and dosimetry. The three most important criteria chosen by medical doctors to determine if ART should be used were overall gross anatomy changes of target and OAR, target not covered by planning target volume (PTV) and OAR close to the high dose area. There was no clear consensus on the minimum improvement in dose to target or reduction in dose to OAR to warrant adaption.Conclusion On-line ART has been implemented successfully internationally. Initial practice maintains conventional professional roles and responsibilities, however there is trend to changing roles for the future. There is little consensus regarding the triggers of adaption..
Hafeez, S.
Patel, E.
Webster, A.
Warren-Oseni, K.
Hansen, V.
McNair, H.
Miles, E.
Lewis, R.
Hall, E.
Huddart, R.
(2020). Protocol for hypofractionated adaptive radiotherapy to the bladder within a multicentre phase II randomised trial: radiotherapy planning and delivery guidance. Bmj open,
Vol.10
(5),
pp. e037134-?.
show abstract
INTRODUCTION:Patients with muscle invasive bladder cancer (MIBC) who are unfit and unsuitable for standard radical treatment with cystectomy or daily radiotherapy present a large unmet clinical need. Untreated, they suffer high cancer specific mortality and risk significant disease-related local symptoms. Hypofractionated radiotherapy (delivering higher doses in fewer fractions/visits) is a potential treatment solution but could be compromised by the mobile nature of the bladder, resulting in target misses in a significant proportion of fractions. Adaptive 'plan of the day' image-guided radiotherapy delivery may improve the precision and accuracy of treatment. We aim to demonstrate within a randomised multicentre phase II trial feasibility of plan of the day hypofractionated bladder radiotherapy delivery with acceptable rates of toxicity. METHODS AND ANALYSIS:Patients with T2-T4aN0M0 MIBC receiving 36 Gy in 6-weekly fractions are randomised (1:1) between treatment delivered using a single-standard plan or adaptive radiotherapy using a library of three plans (small, medium and large). A cone beam CT taken prior to each treatment is used to visualise the anatomy and select the most appropriate plan depending on the bladder shape and size. A comprehensive radiotherapy quality assurance programme has been instituted to ensure standardisation of radiotherapy planning and delivery. The primary endpoint is to exclude >30% acute grade >3 non-genitourinary toxicity at 3 months for adaptive radiotherapy in patients who received >1 fraction (p0=0.7, p1=0.9, α=0.05, β=0.2). Secondary endpoints include local disease control, symptom control, late toxicity, overall survival, patient-reported outcomes and proportion of fractions benefiting from adaptive planning. Target recruitment is 62 patients. ETHICS AND DISSEMINATION:The trial is approved by the London-Surrey Borders Research Ethics Committee (13/LO/1350). The results will be disseminated via peer-reviewed scientific journals, conference presentations and submission to regulatory authorities. TRIAL REGISTRATION NUMBER:NCT01810757..
Hafeez, S.
Webster, A.
Hansen, V.N.
McNair, H.A.
Warren-Oseni, K.
Patel, E.
Choudhury, A.
Creswell, J.
Foroudi, F.
Henry, A.
Kron, T.
McLaren, D.B.
Mitra, A.V.
Mostafid, H.
Saunders, D.
Miles, E.
Griffin, C.
Lewis, R.
Hall, E.
Huddart, R.
(2020). Protocol for tumour-focused dose-escalated adaptive radiotherapy for the radical treatment of bladder cancer in a multicentre phase II randomised controlled trial (RAIDER): radiotherapy planning and delivery guidance. Bmj open,
Vol.10
(12),
pp. e041005-?.
show abstract
Introduction Daily radiotherapy delivered with radiosensitisation offers patients with muscle invasive bladder cancer (MIBC) comparable outcomes to cystectomy with functional organ preservation. Most recurrences following radiotherapy occur within the bladder. Increasing the delivered radiotherapy dose to the tumour may further improve local control. Developments in image-guided radiotherapy have allowed bladder tumour-focused 'plan of the day' radiotherapy delivery. We aim to test within a randomised multicentre phase II trial whether this technique will enable dose escalation with acceptable rates of toxicity.Methods and analysis Patients with T2-T4aN0M0 unifocal MIBC will be randomised (1:1:2) between standard/control whole bladder single plan radiotherapy, standard dose adaptive tumour-focused radiotherapy or dose-escalated adaptive tumour-focused radiotherapy (DART). Adaptive tumour-focused radiotherapy will use a library of three plans (small, medium and large) for treatment. A cone beam CT taken prior to each treatment will be used to visualise the anatomy and inform selection of the most appropriate plan for treatment.Two radiotherapy fractionation schedules (32f and 20f) are permitted. A minimum of 120 participants will be randomised in each fractionation cohort (to ensure 57 evaluable DART patients per cohort).A comprehensive radiotherapy quality assurance programme including pretrial and on-trial components is instituted to ensure standardisation of radiotherapy planning and delivery.The trial has a two-stage non-comparative design. The primary end point of stage I is the proportion of patients meeting predefined normal tissue constraints in the DART group. The primary end point of stage II is late Common Terminology Criteria for Adverse Events grade 3 or worse toxicity aiming to exclude a rate of >20% (80% power and 5% alpha, one sided) in each DART fractionation cohort. Secondary end points include locoregional MIBC control, progression-free survival overall survival and patient-reported outcomes.Ethics and dissemination This clinical trial is approved by the London-Surrey Borders Research Ethics Committee (15/LO/0539). The results when available will be disseminated via peer-reviewed scientific journals, conference presentations and submission to regulatory authorities.Trial registration number NCT02447549; Pre-results..
White, I.
McQuaid, D.
McNair, H.
Dunlop, A.
Court, S.
Hopkins, N.
Thomas, K.
Dearnaley, D.
Bhide, S.
Lalondrelle, S.
(2019). Geometric and dosimetric evaluation of the differences between rigid and deformable registration to assess interfraction motion during pelvic radiotherapy. Physics and imaging in radiation oncology,
Vol.9,
pp. 97-102.
show abstract
Background and purpose Appropriate internal margins are essential to avoid a geographical miss in intensity-modulated radiation therapy (IMRT) for endometrial cancer (EC). This study evaluated interfraction target motion using rigid and non-rigid approximation strategies and calculated internal margins based on random and systematic errors using traditional rigid margin recipes. Dosimetric impact of target motion was also investigated.Materials and methods Cone beam CTs (CBCTs) were acquired days 1-4 and then weekly in 17 patients receiving adjuvant IMRT for EC; a total of 169 CBCTs were analysed. Interfraction motion for the clinical target volume vaginal vault and upper vagina (CTVv) was measured using bony landmarks and deformation vector field displacement (DVFD) within a 1 mm internal wall of CTVv. Patient and population systematic and random errors were estimated and margins calculated. Delivered dose to the CTVv and organs at risk was estimated.Results There was a significant difference in target motion assessment using the different registration strategies (p < 0.05). DVFD up to 30 mm occurred in the anterior/posterior direction, which was not accounted for in PTV margins using rigid margin recipes. Underdosing of CTVv D95% occurred in three patients who had substantial reductions in rectal volume (RV) during treatment. RV relative to the planning CT was moderately correlated with anterior/posterior displacement (r = 0.6) and mean relative RV during treatment was strongly correlated with mean relative RV at CBCT acquired days 1-3 (r = 0.8).Conclusion Complex and extensive geometric changes occur to the CTVv, which are not accounted for in margin recipes using rigid approximation. Contemporary margin recipes and adaptive treatment planning based on non-rigid approximation are recommended..
Eccles, C.L.
Nill, S.
Herbert, T.
Scurr, E.
McNair, H.A.
(2019). Blurring the lines for better visualisation. Radiography,
Vol.25
(1),
pp. 91-93.
Goldsworthy, S.
McNair, H.
Dogramadzi, S.
(2019). Motion Capture Pillow (MCP): A novel method to improve comfort and accuracy in radiotherapy. Clinical medicine,
Vol.19
(Suppl 2),
pp. s103-s103.
Pathmanathan, A.U.
McNair, H.A.
Schmidt, M.A.
Brand, D.H.
Delacroix, L.
Eccles, C.L.
Gordon, A.
Herbert, T.
van As, N.J.
Huddart, R.A.
Tree, A.C.
(2019). Comparison of prostate delineation on multimodality imaging for MR-guided radiotherapy. The british journal of radiology,
Vol.92
(1095),
pp. 20180948-?.
show abstract
Objective: With increasing incorporation of MRI in radiotherapy, we investigate two MRI sequences for prostate delineation in radiographer-led image guidance.Methods: Five therapeutic radiographers contoured the prostate individually on CT, T 2 weighted (T 2 W) and T 2 * weighted (T 2 *W) imaging for 10 patients. Contours were analysed with Monaco ADMIRE (research v. 2.0) to assess interobserver variability and accuracy by comparison with a gold standard clinician contour. Observers recorded time taken for contouring and scored image quality and confidence in contouring.Results: There is good agreement when comparing radiographer contours to the gold-standard for all three imaging types with Dice similarity co-efficient 0.91-0.94, Cohen's κ 0.85-0.91, Hausdorff distance 4.6-7.6 mm and mean distance between contours 0.9-1.2 mm. In addition, there is good concordance between radiographers across all imaging modalities. Both T 2 W and T 2 *W MRI show reduced interobserver variability and improved accuracy compared to CT, this was statistically significant for T 2 *W imaging compared to CT across all four comparison metrics. Comparing MRI sequences reveals significantly reduced interobserver variability and significantly improved accuracy on T 2 *W compared to T 2 W MRI for DSC and Cohen's κ. Both MRI sequences scored significantly higher compared to CT for image quality and confidence in contouring, particularly T 2 *W. This was also reflected in the shorter time for contouring, measuring 15.4, 9.6 and 9.8 min for CT, T 2 W and T 2 *W MRI respectively. Conclusion: Therapeutic radiographer prostate contours are more accurate, show less interobserver variability and are more confidently and quickly outlined on MRI compared to CT, particularly using T 2 *W MRI. Advances in knowledge: Our work is relevant for MRI sequence choice and development of the roles of the interprofessional team in the advancement of MRI-guided radiotherapy..
Mason, S.A.
White, I.M.
O'Shea, T.
McNair, H.A.
Alexander, S.
Kalaitzaki, E.
Bamber, J.C.
Harris, E.J.
Lalondrelle, S.
(2019). Combined Ultrasound and Cone Beam CT Improves Target Segmentation for Image Guided Radiation Therapy in Uterine Cervix Cancer. International journal of radiation oncology, biology, physics,
Vol.104
(3),
pp. 685-693.
show abstract
Purpose Adaptive radiation therapy strategies could account for interfractional uterine motion observed in patients with cervix cancer, but the current cone beam computed tomography (CBCT)-based treatment workflow is limited by poor soft-tissue contrast. The goal of the present study was to determine if ultrasound (US) could be used to improve visualization of the uterus, either as a single modality or in combination with CBCT.Methods and materials Interobserver uterine contour agreement and confidence were compared on 40 corresponding CBCT, US, and CBCT-US-fused images from 11 patients with cervix cancer. Contour agreement was measured using the Dice similarity coefficient (DSC) and mean contour-to-contour distance (MCCD). Observers rated their contour confidence on a scale from 1 to 10. Pairwise Wilcoxon signed-rank tests were used to measure differences in contour agreement and confidence.Results CBCT-US fused images had significantly better contour agreement and confidence than either individual modality (P < .05), with median (interquartile range [IQR]) values of 0.84 (0.11), 1.26 (0.23) mm, and 7 (2) for the DSC, MCCD, and observer confidence ratings, respectively. Contour agreement was similar between US and CBCT, with median (IQR) DSCs of 0.81 (0.17) and 0.82 (0.14) and MCCDs of 1.75 (1.15) mm and 1.62 (0.74) mm. Observers were significantly more confident in their US-based contours than in their CBCT-based contours (P < .05), with median (IQR) confidence ratings of 7 (2.75) versus 5 (4).Conclusions CBCT and US are complementary and improve uterine segmentation precision when combined. Observers could localize the uterus with a similar precision on independent US and CBCT images..
Patel, E.
Tsang, Y.
Baker, A.
Callender, J.
Hafeez, S.
Hall, E.
Hansen, V.N.
Lewis, R.
McNair, H.
Miles, E.
Huddart, R.
(2019). Quality assuring "Plan of the day" selection in a multicentre adaptive bladder trial: Implementation of a pre-accrual IGRT guidance and assessment module. Clinical and translational radiation oncology,
Vol.19,
pp. 27-32.
show abstract
Background and purpose Hypofractionated bladder RT with or without image guided adaptive planning (HYBRID) is a multicentre clinical trial investigating "Plan of the Day" (PoD) adaptive radiotherapy for bladder cancer. To ensure correct PoD selection a pre-accrual guidance and assessment module was developed as part of an image guided radiotherapy quality assurance (IGRT QA) credentialing programme. This study aimed to evaluate its feasibility and effectiveness across multiple recruiting centres.Materials and methods Individuals from participating centres remotely accessed an image database in order to complete the PoD module. An assessment score of ≥83% was required in order to receive QA approval. A questionnaire was used to gather user feedback on the module. PoD decisions for the first patient at each recruiting centre were retrospectively reviewed for protocol adherence.Results 71 radiation therapists (RTTs) from 10 centres completed the PoD module. The median assessment score was 92% (Range: 58-100%) with 79% of RTTs passing the assessment on first attempt. All questionnaire respondents reported that the PoD module prepared them for plan selection. In 51/60 of on-trial treatments reviewed, the PoD selected by the centre agreed with QA reviewers.Conclusions The PoD QA module was successfully implemented in a multicentre trial and enabled pre-accrual assessment of protocol understanding. This increased operator confidence and resulted in appropriate PoD selection on-trial..
McNair, H.
Buijs, M.
(2019). Image guided radiotherapy moving towards real time adaptive radiotherapy; global positioning system for radiotherapy?. Technical innovations & patient support in radiation oncology,
Vol.12,
pp. 1-2.
Alexander, S.E.
Hopkins, N.
Lalondrelle, S.
Taylor, A.
Titmarsh, K.
McNair, H.A.
(2019). RTT-led IGRT for cervix cancer; training, implementation and validation. Technical innovations & patient support in radiation oncology,
Vol.12,
pp. 41-49.
show abstract
Introduction
IGRT in cervical cancer treatment delivery is complex due to significant target and organs at risk (OAR) motion. Implementing image assessment of soft-tissue target and OAR position to improve accuracy is recommended. We report the development and refinement of a training and competency programme (TCP), leading to on-line Radiation Therapist (RTT) led soft-tissue assessment, evaluated by a prospective audit.
Methods and materials
The TCP comprised didactic lectures and practical sessions, supported by a comprehensive workbook. The content was decided by a team comprised of Clinical Oncologists, RTTs, and Physicists. On completion of training, RTT soft-tissue review proficiency (after bony anatomy registration) was assessed against a clinician gold-standard from a database of 20 cervical cancer CBCT images. Reviews were graded pass or fail based on PTV coverage assessment and decision taken in concordance with the gold-standard. Parity was set at ≥80% agreement.The initial TCP (stage one) focussed on offline verification and decision making. Sixteen RTTs completed this stage, four achieved ≥80%. This was not sufficient to support clinical implementation.The TCP was redesigned, more stringent review guidelines and greater anatomy teaching was added. TCP stage two focussed on online verification and decision making supported by a decision flowchart. Twenty-one RTTs completed this TCP, all achieved ≥80%. This supported clinical implementation of RTT-led soft-tissue review under prospective audit conditions.The prospective audit was conducted between March 2017 and August 2017. Daily online review was performed by two trained RTTs. Online review and decision making proficiency was evaluated by a clinician.
Results
Thirteen patients were included in the audit. Daily online RTT-led IGRT was achieved for all 343 fractions. Two-hundred CBCT images were reviewed offline by the clinician; the mean number of reviews per patient was 15. 192/200 (96%) RTT image reviews were in agreement with clinician review, presenting excellent concordance.
Discussion and conclusion
Multidisciplinary involvement in training development, redesign of the TCP and inclusion of summative competency assessment were important factors to support RTT skill development. Consequently, RTT-led cervical cancer soft-tissue IGRT was clinically implemented in the hospital..
Eccles, C.L.
Adair Smith, G.
Bower, L.
Hafeez, S.
Herbert, T.
Hunt, A.
McNair, H.A.
Ofuya, M.
Oelfke, U.
Nill, S.
Huddart, R.A.
PRIMER TMG,
(2019). Magnetic resonance imaging sequence evaluation of an MR Linac system; early clinical experience. Technical innovations & patient support in radiation oncology,
Vol.12,
pp. 56-63.
show abstract
Objectives:To systematically identify the preferred magnetic resonance imaging (MRI) sequences following volunteer imaging on a 1.5 Tesla (T) MR-Linear Accelerator (MR Linac) for future protocol development. Methods:Non-patient volunteers were recruited to a Research and Ethics committee approved prospective MR-only imaging study on a 1.5T MR Linac system. Volunteers attended 1-3 imaging sessions that included a combination of mDixon, T1w, T2w sequences using 2-dimensional (2D) and 3-dimensional (3D) acquisitions. Each sequence was acquired over 2-7 minutes and reviewed by a panel of 3 observers to evaluate image quality using a visual grading analysis based on a 4-point Likert scale. Sequences were acquired and modified iteratively until deemed fit for purpose (online image matching or re-planning) and all observers agreed they were suitable in 3 volunteers. Results:26 volunteers underwent 31 imaging sessions of six general anatomical regions. Images were acquired in one or two of six general anatomical regions: male pelvis (n = 9), female pelvis (n = 4), chestwall/breast (n = 5), lung/oesophagus (n = 5), abdomen (n = 3) and head and neck (n = 5). Images were acquired using a pre-defined exam-card that on average, included six sequences (range 2-10), with a maximum scan time of approximately one hour. The majority of observers preferred T2-weighted sequences. The thorax teams were the only groups to prefer T1-weighted imaging. Conclusions:An iterative process identified sequence agreement in all anatomical regions. These sequences will now be evaluated in patient volunteers. Advances in knowledge:This manuscript is the first publication sharing the results of the first systematic selection of MRI sequences for use in on-board MRI-guided radiotherapy by end-users (therapeutic radiographers and clinical oncologists) in healthy volunteers..
Edmunds, D.M.
Gothard, L.
Khabra, K.
Kirby, A.
Madhale, P.
McNair, H.
Roberts, D.
Tang, K.K.
Symonds-Tayler, R.
Tahavori, F.
Wells, K.
Donovan, E.
(2018). Low-cost Kinect Version 2 imaging system for breath hold monitoring and gating: Proof of concept study for breast cancer VMAT radiotherapy. ,
Vol.19
(3),
pp. 71-78.
show abstract
Voluntary inspiration breath hold (VIBH) for left breast cancer patients has been shown to be a safe and effective method of reducing radiation dose to the heart. Currently, VIBH protocol compliance is monitored visually. In this work, we establish whether it is possible to gate the delivery of radiation from an Elekta linac using the Microsoft Kinect version 2 (Kinect v2) depth sensor to measure a patient breathing signal. This would allow contactless monitoring during VMAT treatment, as an alternative to equipment-assisted methods such as active breathing control (ABC). Breathing traces were acquired from six left breast radiotherapy patients during VIBH. We developed a gating interface to an Elekta linac, using the depth signal from a Kinect v2 to control radiation delivery to a programmable motion platform following patient breathing patterns. Radiation dose to a moving phantom with gating was verified using point dose measurements and a Delta4 verification phantom. 60 breathing traces were obtained with an acquisition success rate of 100%. Point dose measurements for gated deliveries to a moving phantom agreed to within 0.5% of ungated delivery to a static phantom using both a conventional and VMAT treatment plan. Dose measurements with the verification phantom showed that there was a median dose difference of better than 0.5% and a mean (3% 3 mm) gamma index of 92.6% for gated deliveries when using static phantom data as a reference. It is possible to use a Kinect v2 device to monitor voluntary breath hold protocol compliance in a cohort of left breast radiotherapy patients. Furthermore, it is possible to use the signal from a Kinect v2 to gate an Elekta linac to deliver radiation only during the peak inhale VIBH phase..
Grimwood, A.
McNair, H.A.
O'Shea, T.P.
Gilroy, S.
Thomas, K.
Bamber, J.C.
Tree, A.C.
Harris, E.J.
(2018). In Vivo Validation of Elekta's Clarity Autoscan for Ultrasound-based Intrafraction Motion Estimation of the Prostate During Radiation Therapy. International journal of radiation oncology, biology, physics,
Vol.102
(4),
pp. 912-921.
show abstract
PURPOSE:Our purpose was to perform an in vivo validation of ultrasound imaging for intrafraction motion estimation using the Elekta Clarity Autoscan system during prostate radiation therapy. The study was conducted as part of the Clarity-Pro trial (NCT02388308). METHODS AND MATERIALS:Initial locations of intraprostatic fiducial markers were identified from cone beam computed tomography scans. Marker positions were translated according to Clarity intrafraction 3-dimensional prostate motion estimates. The updated locations were projected onto the 2-dimensional electronic portal imager plane. These Clarity-based estimates were compared with the actual portal-imaged 2-dimensional marker positions. Images from 16 patients encompassing 80 fractions were analyzed. To investigate the influence of intraprostatic markers and image quality on ultrasound motion estimation, 3 observers rated image quality, and the marker visibility on ultrasound images was assessed. RESULTS:The median difference between Clarity-defined intrafraction marker locations and portal-imaged marker locations was 0.6 mm (with 95% limit of agreement at 2.5 mm). Markers were identified on ultrasound in only 3 of a possible 240 instances. No linear relationship between image quality and Clarity motion estimation confidence was identified. The difference between Clarity-based motion estimates and electronic portal-imaged marker location was also independent of image quality. Clarity estimation confidence was degraded in a single fraction owing to poor probe placement. CONCLUSIONS:The accuracy of Clarity intrafraction prostate motion estimation is comparable with that of other motion-monitoring systems in radiation therapy. The effect of fiducial markers in the study was deemed negligible as they were rarely visible on ultrasound images compared with intrinsic anatomic features. Clarity motion estimation confidence was robust to variations in image quality and the number of ultrasound-imaged anatomic features; however, it was degraded as a result of poor probe placement..
Bartlett, F.R.
Donovan, E.M.
McNair, H.A.
Corsini, L.A.
Colgan, R.M.
Evans, P.M.
Maynard, L.
Griffin, C.
Haviland, J.S.
Yarnold, J.R.
Kirby, A.M.
(2017). The UK HeartSpare Study (Stage II): Multicentre Evaluation of a Voluntary Breath-hold Technique in Patients Receiving Breast Radiotherapy. Clinical oncology (royal college of radiologists (great britain)),
Vol.29
(3),
pp. e51-e56.
show abstract
Aims To evaluate the feasibility and heart-sparing ability of the voluntary breath-hold (VBH) technique in a multicentre setting.Materials and methods Patients were recruited from 10 UK centres. Following surgery for early left breast cancer, patients with any heart inside the 50% isodose from a standard free-breathing tangential field treatment plan underwent a second planning computed tomography (CT) scan using the VBH technique. A separate treatment plan was prepared on the VBH CT scan and used for treatment. The mean heart, left anterior descending coronary artery (LAD) and lung doses were calculated. Daily electronic portal imaging (EPI) was carried out and scanning/treatment times were recorded. The primary end point was the percentage of patients achieving a reduction in mean heart dose with VBH. Population systematic (Σ) and random errors (σ) were estimated. Within-patient comparisons between techniques used Wilcoxon signed-rank tests.Results In total, 101 patients were recruited during 2014. Primary end point data were available for 93 patients, 88 (95%) of whom achieved a reduction in mean heart dose with VBH. Mean cardiac doses (Gy) for free-breathing and VBH techniques, respectively, were: heart 1.8 and 1.1, LAD 12.1 and 5.4, maximum LAD 35.4 and 24.1 (all P<0.001). Population EPI-based displacement data showed Σ =+1.3-1.9 mm and σ=1.4-1.8 mm. Median CT and treatment session times were 21 and 22 min, respectively.Conclusions The VBH technique is confirmed as effective in sparing heart tissue and is feasible in a multicentre setting..
Hafeez, S.
McDonald, F.
Lalondrelle, S.
McNair, H.
Warren-Oseni, K.
Jones, K.
Harris, V.
Taylor, H.
Khoo, V.
Thomas, K.
Hansen, V.
Dearnaley, D.
Horwich, A.
Huddart, R.
(2017). Clinical Outcomes of Image Guided Adaptive Hypofractionated Weekly Radiation Therapy for Bladder Cancer in Patients Unsuitable for Radical Treatment. International journal of radiation oncology, biology, physics,
Vol.98
(1),
pp. 115-122.
show abstract
Purpose and objectives We report on the clinical outcomes of a phase 2 study assessing image guided hypofractionated weekly radiation therapy in bladder cancer patients unsuitable for radical treatment.Methods and materials Fifty-five patients with T2-T4aNx-2M0-1 bladder cancer not suitable for cystectomy or daily radiation therapy treatment were recruited. A "plan of the day" radiation therapy approach was used, treating the whole (empty) bladder to 36 Gy in 6 weekly fractions. Acute toxicity was assessed weekly during radiation therapy, at 6 and 12 weeks using the Common Terminology Criteria for Adverse Events version 3.0. Late toxicity was assessed at 6 months and 12 months using Radiation Therapy Oncology Group grading. Cystoscopy was used to assess local control at 3 months. Cumulative incidence function was used to determine local progression at 1 at 2 years. Death without local progression was treated as a competing risk. Overall survival was estimated using the Kaplan-Meier method.Results Median age was 86 years (range, 68-97 years). Eighty-seven percent of patients completed their prescribed course of radiation therapy. Genitourinary and gastrointestinal grade 3 acute toxicity was seen in 18% (10/55) and 4% (2/55) of patients, respectively. No grade 4 genitourinary or gastrointestinal toxicity was seen. Grade ≥3 late toxicity (any) at 6 and 12 months was seen in 6.5% (2/31) and 4.3% (1/23) of patients, respectively. Local control after radiation therapy was 92% of assessed patients (60% total population). Cumulative incidence of local progression at 1 year and 2 years for all patients was 7% (95% confidence interval [CI] 2%-17%) and 17% (95% CI 8%-29%), respectively. Overall survival at 1 year was 63% (95% CI 48%-74%).Conclusion Hypofractionated radiation therapy delivered weekly with a plan of the day approach offers good local control with acceptable toxicity in a patient population not suitable for radical bladder treatment..
Wedlake, L.
Shaw, C.
McNair, H.
Lalji, A.
Mohammed, K.
Klopper, T.
Allan, L.
Tait, D.
Hawkins, M.
Somaiah, N.
Lalondrelle, S.
Taylor, A.
VanAs, N.
Stewart, A.
Essapen, S.
Gage, H.
Whelan, K.
Andreyev, H.J.
(2017). Randomized controlled trial of dietary fiber for the prevention of radiation-induced gastrointestinal toxicity during pelvic radiotherapy. The american journal of clinical nutrition,
Vol.106
(3),
pp. 849-857.
show abstract
Background: Therapeutic radiotherapy is an important treatment of pelvic cancers. Historically, low-fiber diets have been recommended despite a lack of evidence and potentially beneficial mechanisms of fiber. Objective: This randomized controlled trial compared low-, habitual-, and high-fiber diets for the prevention of gastrointestinal toxicity in patients undergoing pelvic radiotherapy. Design: Patients were randomly assigned to low-fiber [≤10 g nonstarch polysaccharide (NSP)/d], habitual-fiber (control), or high-fiber (≥18 g NSP/d) diets and received individualized counseling at the start of radiotherapy to achieve these targets. The primary endpoint was the difference between groups in the change in the Inflammatory Bowel Disease Questionnaire-Bowel Subset (IBDQ-B) score between the starting and nadir (worst) score during treatment. Other measures included macronutrient intake, stool diaries, and fecal short-chain fatty acid concentrations. Results: Patients were randomly assigned to low-fiber ( n = 55), habitual-fiber ( n = 55), or high-fiber ( n = 56) dietary advice. Fiber intakes were significantly different between groups ( P < 0.001). The difference between groups in the change in IBDQ-B scores between the start and nadir was not significant ( P = 0.093). However, the change in score between the start and end of radiotherapy was smaller in the high-fiber group (mean ± SD: -3.7 ± 12.8) than in the habitual-fiber group (-10.8 ± 13.5; P = 0.011). At 1-y postradiotherapy ( n = 126) the difference in IBDQ-B scores between the high-fiber (+0.1 ± 14.5) and the habitual-fiber (-8.4 ± 13.3) groups was significant ( P = 0.004). No significant differences were observed in stool frequency or form or in short-chain fatty acid concentrations. Significant reductions in energy, protein, and fat intake occurred in the low- and habitual-fiber groups only. Conclusions: Dietary advice to follow a high-fiber diet during pelvic radiotherapy resulted in reduced gastrointestinal toxicity both acutely and at 1 y compared with habitual-fiber intake. Restrictive, non-evidence-based advice to reduce fiber intake in this setting should be abandoned. This trial was registered at clinicaltrials.gov as NCT 01170299..
Eccles, C.L.
McNair, H.A.
Armstrong, S.E.
Helyer, S.J.
Scurr, E.D.
(2017). In response to Westbrook - Opening the debate on MRI practitioner education. Radiography (london, england : 1995),
Vol.23 Suppl 1,
pp. S75-S76.
Reis Ferreira, M.
Khan, A.
Thomas, K.
Truelove, L.
McNair, H.
Gao, A.
Parker, C.C.
Huddart, R.
Bidmead, M.
Eeles, R.
Khoo, V.
van As, N.J.
Hansen, V.N.
Dearnaley, D.P.
(2017). Phase 1/2 Dose-Escalation Study of the Use of Intensity Modulated Radiation Therapy to Treat the Prostate and Pelvic Nodes in Patients With Prostate Cancer. International journal of radiation oncology, biology, physics,
Vol.99
(5),
pp. 1234-1242.
show abstract
Purpose To investigate the feasibility of dose escalation and hypofractionation of pelvic lymph node intensity modulated radiation therapy (PLN-IMRT) in prostate cancer (PCa).Methods and materials In a phase 1/2 study, patients with advanced localized PCa were sequentially treated with 70 to 74 Gy to the prostate and dose-escalating PLN-IMRT at doses of 50 Gy (cohort 1), 55 Gy (cohort 2), and 60 Gy (cohort 3) in 35 to 37 fractions. Two hypofractionated cohorts received 60 Gy to the prostate and 47 Gy to PLN in 20 fractions over 4 weeks (cohort 4) and 5 weeks (cohort 5). All patients received long-course androgen deprivation therapy. Primary outcome was late Radiation Therapy Oncology Group toxicity at 2 years after radiation therapy for all cohorts. Secondary outcomes were acute and late toxicity using other clinician/patient-reported instruments and treatment efficacy.Results Between August 9, 2000, and June 9, 2010, 447 patients were enrolled. Median follow-up was 90 months. The 2-year rates of grade 2+ bowel/bladder toxicity were as follows: cohort 1, 8.3%/4.2% (95% confidence interval 2.2%-29.4%/0.6%-26.1%); cohort 2, 8.9%/5.9% (4.1%-18.7%/2.3%-15.0%); cohort 3, 13.2%/2.9% (8.6%-20.2%/1.1%-7.7%); cohort 4, 16.4%/4.8% (9.2%-28.4%/1.6%-14.3%); cohort 5, 12.2%/7.3% (7.6%-19.5%/3.9%-13.6%). Prevalence of bowel and bladder toxicity seemed to be stable over time. Other scales mirrored these results. The biochemical/clinical failure-free rate was 71% (66%-75%) at 5 years for the whole group, with pelvic lymph node control in 94% of patients.Conclusions This study shows the safety and tolerability of PLN-IMRT. Ongoing and planned phase 3 studies will need to demonstrate an increase in efficacy using PLN-IMRT to offset the small increase in bowel side effects compared with prostate-only IMRT..
Hafeez, S.
Warren-Oseni, K.
McNair, H.A.
Hansen, V.N.
Jones, K.
Tan, M.
Khan, A.
Harris, V.
McDonald, F.
Lalondrelle, S.
Mohammed, K.
Thomas, K.
Thompson, A.
Kumar, P.
Dearnaley, D.
Horwich, A.
Huddart, R.
(2016). Prospective Study Delivering Simultaneous Integrated High-dose Tumor Boost (≤70 Gy) With Image Guided Adaptive Radiation Therapy for Radical Treatment of Localized Muscle-Invasive Bladder Cancer. International journal of radiation oncology, biology, physics,
Vol.94
(5),
pp. 1022-1030.
show abstract
Purpose Image guided adaptive radiation therapy offers individualized solutions to improve target coverage and reduce normal tissue irradiation, allowing the opportunity to increase the radiation tumor dose and spare normal bladder tissue.Methods and materials A library of 3 intensity modulated radiation therapy plans were created (small, medium, and large) from planning computed tomography (CT) scans performed at 30 and 60 minutes; treating the whole bladder to 52 Gy and the tumor to 70 Gy in 32 fractions. A "plan of the day" approach was used for treatment delivery. A post-treatment cone beam CT (CBCT) scan was acquired weekly to assess intrafraction filling and coverage.Results A total of 18 patients completed treatment to 70 Gy. The plan and treatment for 1 patient was to 68 Gy. Also, 1 patient's plan was to 70 Gy but the patient was treated to a total dose of 65.6 Gy because dose-limiting toxicity occurred before dose escalation. A total of 734 CBCT scans were evaluated. Small, medium, and large plans were used in 36%, 48%, and 16% of cases, respectively. The mean ± standard deviation rate of intrafraction filling at the start of treatment (ie, week 1) was 4.0 ± 4.8 mL/min (range 0.1-19.4) and at end of radiation therapy (ie, week 5 or 6) was 1.1 ± 1.6 mL/min (range 0.01-7.5; P=.002). The mean D98 (dose received by 98% volume) of the tumor boost and bladder as assessed on the post-treatment CBCT scan was 97.07% ± 2.10% (range 89.0%-104%) and 99.97% ± 2.62% (range 96.4%-112.0%). At a median follow-up period of 19 months (range 4-33), no muscle-invasive recurrences had developed. Two patients experienced late toxicity (both grade 3 cystitis) at 5.3 months (now resolved) and 18 months after radiation therapy.Conclusions Image guided adaptive radiation therapy using intensity modulated radiation therapy to deliver a simultaneous integrated tumor boost to 70 Gy is feasible, with acceptable toxicity, and will be evaluated in a randomized trial..
Kember, S.A.
Hansen, V.N.
Fast, M.F.
Nill, S.
McDonald, F.
Ahmed, M.
Thomas, K.
McNair, H.A.
(2016). Evaluation of three presets for four-dimensional cone beam CT in lung radiotherapy verification by visual grading analysis. The british journal of radiology,
Vol.89
(1063),
pp. 20150933-?.
show abstract
Objective To evaluate three image acquisition presets for four-dimensional cone beam CT (CBCT) to identify an optimal preset for lung tumour image quality while minimizing dose and acquisition time.Methods Nine patients undergoing radical conventionally fractionated radiotherapy for lung cancer had verification CBCTs acquired using three presets: Preset 1 on Day 1 (11 mGy dose, 240 s acquisition time), Preset 2 on Day 2 (9 mGy dose, 133 s acquisition time) and Preset 3 on Day 3 (9 mGy dose, 67 s acquisition time). The clarity of the tumour and other thoracic structures, and the acceptability of the match, were retrospectively graded by visual grading analysis (VGA). Logistic regression was used to identify the most appropriate preset and any factors that might influence the result.Results Presets 1 and 2 met a clinical requirement of 75% of structures to be rated "Clear" or above and 75% of matches to be rated "Acceptable" or above. Clarity is significantly affected by preset, patient, observer and structure. Match acceptability is significantly affected by preset.Conclusion The application of VGA in this initial study enabled a provisional selection of an optimal preset (Preset 2) to be made.Advances in knowledge This was the first application of VGA to the investigation of presets for CBCT..
Landeg, S.J.
Kirby, A.M.
Lee, S.F.
Bartlett, F.
Titmarsh, K.
Donovan, E.
Griffin, C.L.
Gothard, L.
Locke, I.
McNair, H.A.
(2016). A randomized control trial evaluating fluorescent ink versus dark ink tattoos for breast radiotherapy. The british journal of radiology,
Vol.89
(1068),
pp. 20160288-?.
show abstract
Objective The purpose of this UK study was to evaluate interfraction reproducibility and body image score when using ultraviolet (UV) tattoos (not visible in ambient lighting) for external references during breast/chest wall radiotherapy and compare with conventional dark ink.Methods In this non-blinded, single-centre, parallel group, randomized control trial, patients were allocated to receive either conventional dark ink or UV ink tattoos using computer-generated random blocks. Participant assignment was not masked. Systematic (∑) and random (σ) setup errors were determined using electronic portal images. Body image questionnaires were completed at pre-treatment, 1 month and 6 months to determine the impact of tattoo type on body image. The primary end point was to determine that UV tattoo random error (σ setup ) was no less accurate than with conventional dark ink tattoos, i.e. <2.8 mm.Results 46 patients were randomized to receive conventional dark or UV ink tattoos. 45 patients completed treatment (UV: n = 23, dark: n = 22). σ setup for the UV tattoo group was <2.8 mm in the u and v directions (p = 0.001 and p = 0.009, respectively). A larger proportion of patients reported improvement in body image score in the UV tattoo group compared with the dark ink group at 1 month [56% (13/23) vs 14% (3/22), respectively] and 6 months [52% (11/21) vs 38% (8/21), respectively].Conclusion UV tattoos were associated with interfraction setup reproducibility comparable with conventional dark ink. Patients reported a more favourable change in body image score up to 6 months following treatment. Advances in knowledge: This study is the first to evaluate UV tattoo external references in a randomized control trial..
Kaza, E.
Collins, D.
Symonds-Tayler, R.
McDonald, F.
Scurr, E.
McNair, H.
Hansen, V.
Leach, M.
(2015). 143: Magnetic resonance imaging (MRI) in patients with non-small cell lung cancer (NSCLC) using active breathing coordinator motion control. Lung cancer,
Vol.87,
pp. S52-S52.
Bartlett, F.R.
Colgan, R.M.
Donovan, E.M.
McNair, H.A.
Carr, K.
Evans, P.M.
Griffin, C.
Locke, I.
Haviland, J.S.
Yarnold, J.R.
Kirby, A.M.
(2015). The UK HeartSpare Study (Stage IB): Randomised comparison of a voluntary breath-hold technique and prone radiotherapy after breast conserving surgery. Radiotherapy and oncology,
Vol.114
(1),
pp. 66-72.
Hudson, J.
Doolan, C.
McDonald, F.
Locke, I.
Ahmed, M.
Gunapala, G.
McNair, H.
(2015). Are therapeutic radiographers able to achieve clinically acceptable verification for stereotactic lung radiotherapy treatment (SBRT)?. Journal of radiotherapy in practice,
Vol.14
(1),
pp. 10-17.
show abstract
AbstractPurposeThe aim of this study was to assess the feasibility of radiographer led verification of cone-beam computed tomography (CBCT) images for patients with solitary lung tumours treated with stereotactic body radiotherapy treatment (SBRT).Material and methodsCBCT setup images of 20 patients from the first fraction of each patient were retrospectively registered by therapeutic radiographers. The displacements recorded were compared with the clinical oncologist’s original online match. The time taken by radiographers to verify the CBCT images was also recorded.ResultsOverall agreement for all radiographers when compared with the clinical oncologist match was 91%. Interobserver variations between radiographers were X plane 0·87 (0·76–0·94); Y plane 0·74 (0·51–0·88); and Z plane 0·88 (0·78–0·95) intraclass correlation coefficient and 95% confidence interval. The average time taken for verification was 128 seconds.ConclusionTherapeutic radiographers are able to verify CBCT images for thorax SBRT with results comparable to the ‘gold standard’ clinical oncologists’ match, however additional training will be provided for online verification. The time taken was within acceptable limits..
McNair, H.A.
Hafeez, S.
Taylor, H.
Lalondrelle, S.
McDonald, F.
Hansen, V.N.
Huddart, R.
(2015). Radiographer-led plan selection for bladder cancer radiotherapy: initiating a training programme and maintaining competency. The british journal of radiology,
Vol.88
(1048),
pp. 20140690-20140690.
Probst, H.
Harris, R.
McNair, H.A.
Baker, A.
Miles, E.A.
Beardmore, C.
(2015). Research from therapeutic radiographers: An audit of research capacity within the UK. Radiography,
Vol.21
(2),
pp. 112-118.
Harris, V.A.
Staffurth, J.
Naismith, O.
Esmail, A.
Gulliford, S.
Khoo, V.
Lewis, R.
Littler, J.
McNair, H.
Sadoyze, A.
Scrase, C.
Sohaib, A.
Syndikus, I.
Zarkar, A.
Hall, E.
Dearnaley, D.
(2015). Consensus Guidelines and Contouring Atlas for Pelvic Node Delineation in Prostate and Pelvic Node Intensity Modulated Radiation Therapy. International journal of radiation oncology*biology*physics,
Vol.92
(4),
pp. 874-883.
McNair, H.A.
Harris, E.J.
Hansen, V.N.
Thomas, K.
South, C.
Hafeez, S.
Huddart, R.
Dearnaley, D.P.
(2015). Magnitude of observer error using cone beam CT for prostate interfraction motion estimation: effect of reducing scan length or increasing exposure. The british journal of radiology,
Vol.88
(1054),
pp. 20150208-?.
show abstract
Objective Cone beam CT (CBCT) enables soft-tissue registration to planning CT for position verification in radiotherapy. The aim of this study was to determine the interobserver error (IOE) in prostate position verification using a standard CBCT protocol, and the effect of reducing CBCT scan length or increasing exposure, compared with standard imaging protocol.Methods CBCT images were acquired using a novel 7 cm length image with standard exposure (1644 mAs) at Fraction 1 (7), standard 12 cm length image (1644 mAs) at Fraction 2 (12) and a 7 cm length image with higher exposure (2632 mAs) at Fraction 3 (7H) on 31 patients receiving radiotherapy for prostate cancer. Eight observers (two clinicians and six radiographers) registered the images. Guidelines and training were provided. The means of the IOEs were compared using a Kruzkal-Wallis test. Levene's test was used to test for differences in the variances of the IOEs and the independent prostate position.Results No significant difference was found between the IOEs of each image protocol in any direction. Mean absolute IOE was the greatest in the anteroposterior direction. Standard deviation (SD) of the IOE was the least in the left-right direction for each of the three image protocols. The SD of the IOE was significantly less than the independent prostate motion in the anterior-posterior (AP) direction only (1.8 and 3.0 mm, respectively: p = 0.017). IOEs were within 1 SD of the independent prostate motion in 95%, 77% and 96% of the images in the RL, SI and AP direction.Conclusion Reducing CBCT scan length and increasing exposure did not have a significant effect on IOEs. To reduce imaging dose, a reduction in CBCT scan length could be considered without increasing the uncertainty in prostate registration. Precision of CBCT verification of prostate radiotherapy is affected by IOE and should be quantified prior to implementation.Advances in knowledge This study shows the importance of quantifying the magnitude of IOEs prior to CBCT implementation..
Lacey, C.
Ockwell, C.
Locke, I.
Thomas, K.
Hendry, J.
McNair, H.
(2015). A prospective study comparing radiographer- and clinician-based localization for patients with metastatic spinal cord compression (MSCC) to assess the feasibility of a radiographer-led service. The british journal of radiology,
Vol.88
(1055),
pp. 20150586-20150586.
Kaza, E.
Symonds-Tayler, R.
Collins, D.J.
McDonald, F.
McNair, H.A.
Scurr, E.
Koh, D.-.
Leach, M.O.
(2015). First MRI application of an active breathing coordinator. Physics in medicine and biology,
Vol.60
(4),
pp. 1681-1696.
Yeoh, K.-.
McNair, H.A.
McDonald, F.
Hawkins, M.
Hansen, V.N.
Ramos, M.
Fragkandrea, I.
Bothwell, S.
Herbert, T.
Taylor, H.
Helyer, S.
Ashley, S.
Brada, M.
(2014). Cone beam CT verification for active breathing control (ABC)-gated radiotherapy for lung cancer. Acta oncologica,
Vol.53
(5),
pp. 716-719.
McNair, H.A.
Elsworthy, M.
Dean, J.
Beardmore, C.
(2014). Image guided radiotherapy: Current status of soft tissue imaging. Radiography,
Vol.20
(2),
pp. 158-161.
Hafeez, S.
McNair, H.
Warren-Oseni, K.
Hansen, V.
Huddart, R.
(2014). Audit of Radiographer Led Plan Selection in Imaged Guided Adaptive Radiotherapy (IGART) for Bladder Cancer. Clinical oncology,
Vol.26,
pp. S7-S8.
McNair, H.A.
Wedlake, L.
Lips, I.M.
Andreyev, J.
Van Vulpen, M.
Dearnaley, D.
(2014). A systematic review: Effectiveness of rectal emptying preparation in prostate cancer patients. Practical radiation oncology,
Vol.4
(6),
pp. 437-447.
Rosenfelder, N.A.
Corsini, L.
McNair, H.
Pennert, K.
Burke, K.
Lamb, C.M.
Aitken, A.
Ashley, S.
Khoo, V.
Brada, M.
(2013). Achieving the Relocation Accuracy of Stereotactic Frame-based Cranial Radiotherapy in a Three-point Thermoplastic Shell. Clinical oncology,
Vol.25
(1),
pp. 66-73.
Lee, Y.K.
Bedford, J.L.
McNair, H.A.
Hawkins, M.A.
(2013). Comparison of deliverable IMRT and VMAT for spine metastases using a simultaneous integrated boost. The british journal of radiology,
Vol.86
(1022),
pp. 20120466-20120466.
Rosenfelder, N.A.
Corsini, L.
McNair, H.
Pennert, K.
Aitken, A.
Lamb, C.M.
Long, M.
Clarke, E.
Murcia, M.
Schick, U.
Burke, K.
Ashley, S.
Khoo,, V.
Brada, M.
(2013). Comparison of setup accuracy and intrafraction motion using stereotactic frame versus 3-point thermoplastic mask-based immobilization for fractionated cranial image guided radiation therapy. Practical radiation oncology,
Vol.3
(3),
pp. 171-179.
Bartlett, F.R.
Colgan, R.M.
Carr, K.
Donovan, E.M.
McNair, H.A.
Locke, I.
Evans, P.M.
Haviland, J.S.
Yarnold, J.R.
Kirby, A.M.
(2013). The UK HeartSpare Study: Randomised evaluation of voluntary deep-inspiratory breath-hold in women undergoing breast radiotherapy. Radiotherapy and oncology,
Vol.108
(2),
pp. 242-247.
McDonald, F.
Lalondrelle, S.
Taylor, H.
Warren-Oseni, K.
Khoo, V.
McNair, H.A.
Harris, V.
Hafeez, S.
Hansen, V.N.
Thomas, K.
Jones, K.
Dearnaley, D.
Horwich, A.
Huddart, R.
(2013). Clinical Implementation of Adaptive Hypofractionated Bladder Radiotherapy for Improvement in Normal Tissue Irradiation. Clinical oncology,
Vol.25
(9),
pp. 549-556.
McNair, H.A.
Wedlake, L.
Shaw, C.
Andreyev, J.
Dearnaley, D.
(2013). Recording a patient diet over the radical course of radiotherapy for prostate cancer using a diet diary: a feasibility study. Journal of radiotherapy in practice,
Vol.12
(3),
pp. 281-282.
Mcnair, H.A.
Kavanagh, A.
Powell, C.
Symonds-Tayler, J.R.
Brada, M.
Evans, P.M.
(2012). Fluoroscopy as a surrogate for lung tumour motion. The british journal of radiology,
Vol.85
(1010),
pp. 168-175.
Brock, J.
Bedford, J.
Partridge, M.
McDonald, F.
Ashley, S.
McNair, H.A.
Brada, M.
(2012). Optimising Stereotactic Body Radiotherapy for Non-small Cell Lung Cancer with Volumetric Intensity-modulated Arc Therapy—A Planning Study. Clinical oncology,
Vol.24
(1),
pp. 68-75.
d’Aquino, A.
Harrison, S.
Helyer, S.
Dearnaley, D.
McNair, H.
(2012). Set-up accuracy of an external immobilisation system for patients receiving radical radiotherapy for prostate cancer. Journal of radiotherapy in practice,
Vol.11
(3),
pp. 155-161.
show abstract
AbstractPurpose: To evaluate the accuracy of an external immobilisation system in patients receiving radiotherapy for prostate cancer.Methods: Portal Imaging data were audited in 20 patients treated using an in-house immobilisation system and 20 patients treated using an indexed commercial immobilisation system (Combifix™). Individual and group random and systematic errors were calculated to determine the accuracy of set-up using skin marks alone and with a no-action-level protocol.Results: The initial results showed a larger systematic error in the Combifix™ in the anterior-posterior direction (2.7 mm) compared with the in-house system (1.5 mm). The possible source of this was identified as the difficulty in accurately aligning the laser to a curved couch top prior to setting the isocentre height. A change in the process of setting the isocentre was introduced, and comparable baseline set-up accuracy was achieved. This was with a systematic error of ≤2.0 mm and a random error ≤1.5 mm of patient position set-up error with skin marks alone, and using the Combifix™. The systematic errors were further reduced to <1 mm with an off-line no-action-level protocol.Conclusion: Using the Combifix™ system a high level of set-up accuracy was reproduced in routine daily practice..
Franks, K.N.
McNair, H.A.
(2012). Implementation of Image-guided Radiotherapy. Clinical oncology,
Vol.24
(9),
pp. 625-626.
Lalondrelle, S.
Huddart, R.
Warren-Oseni, K.
Hansen, V.N.
McNair, H.
Thomas, K.
Dearnaley, D.
Horwich, A.
Khoo, V.
(2011). Adaptive-predictive organ localization using cone-beam computed tomography for improved accuracy in external beam radiotherapy for bladder cancer. Int j radiat oncol biol phys,
Vol.79
(3),
pp. 705-712.
show abstract
To examine patterns of bladder wall motion during high-dose hypofractionated bladder radiotherapy and to validate a novel adaptive planning method, A-POLO, to prevent subsequent geographic miss..
Hawkins, M.A.
Aitken, A.
Hansen, V.N.
McNair, H.A.
Tait, D.M.
(2011). Set-up errors in radiotherapy for oesophageal cancers – Is electronic portal imaging or conebeam more accurate?. Radiotherapy and oncology,
Vol.98
(2),
pp. 249-254.
Boda-Heggemann, J.
Fleckenstein, J.
Lohr, F.
Wertz, H.
Nachit, M.
Blessing, M.
Stsepankou, D.
Löb, I.
Küpper, B.
Kavanagh, A.
Hansen, V.N.
Brada, M.
Wenz, F.
McNair, H.
(2011). Multiple breath-hold CBCT for online image guided radiotherapy of lung tumors: Simulation with a dynamic phantom and first patient data. Radiotherapy and oncology,
Vol.98
(3),
pp. 309-316.
McNair, H.A.
Wedlake, L.
McVey, G.P.
Thomas, K.
Andreyev, J.
Dearnaley, D.P.
(2011). Can diet combined with treatment scheduling achieve consistency of rectal filling in patients receiving radiotherapy to the prostate?. Radiother oncol,
.
show abstract
BACKGROUND AND PURPOSE: This pilot study investigates whether an individualized fluid and fibre prescription combined with a constant treatment can improve rectal filling consistency during radiotherapy. METHODS AND MATERIALS: Fibre, fluid intake and bowel function were assessed in 22 patients at a standard planning scan (SCT) and individualized dietary advice was prescribed to regularize bowel habit. Patients were requested to record frequency and type of bowel movements, fibre and fluid intake daily. Two subsequent CT scans were acquired at 7 (CCT1) and 10days (CCT2) after SCT at a similar time. Rectal volume and gas were measured planning CT's and 'on treatment' cone beam CT scans. We hypothesised that the difference in volume between CCT1 and CCT2 would be less than the difference between SCT and CCT1. RESULTS: The mean (SD) change in volume between SCT to CCT1 and CCT1 to CCT2 was 5.68cm(3) (26.2) and -8.6cm(3) (40.1), respectively (p=0.292). Of the 22 patients scanned 20 provided a complete record of dietary intake and bowel motion. The majority of patients either achieved or exceeded prescription. Change in rectal gas was the only correlation with change in rectal volume. CONCLUSION: Patient self reporting of bowel motion, fibre, fluid intake was achievable but consistency of rectal filling was not improved. Improved understanding of the aetiology and management of rectal gas is indicated..
Brock, J.
McNair, H.A.
Panakis, N.
Symonds-Tayler, R.
Evans, P.M.
Brada, M.
(2011). The Use of the Active Breathing Coordinator Throughout Radical Non–Small-Cell Lung Cancer (NSCLC) Radiotherapy. International journal of radiation oncology*biology*physics,
Vol.81
(2),
pp. 369-375.
Chong, I.
Hawkins, M.
Hansen, V.
Thomas, K.
McNair, H.
O’Neill, B.
Aitken, A.
Tait, D.
(2011). Quantification of Organ Motion During Chemoradiotherapy of Rectal Cancer Using Cone-Beam Computed Tomography. International journal of radiation oncology*biology*physics,
Vol.81
(4),
pp. e431-e438.
Hawkins, M.A.
Aitken, A.
Hansen, V.N.
McNair, H.A.
Tait, D.M.
(2011). Cone beam CT verification for oesophageal cancer – impact of volume selected for image registration. Acta oncologica,
Vol.50
(8),
pp. 1183-1190.
Korreman, S.
Rasch, C.
McNair, H.
Verellen, D.
Oelfke, U.
Maingon, P.
Mijnheer, B.
Khoo, V.
(2010). The European Society of Therapeutic Radiology and Oncology–European Institute of Radiotherapy (ESTRO–EIR) report on 3D CT-based in-room image guidance systems: A practical and technical review and guide. Radiotherapy and oncology,
Vol.94
(2),
pp. 129-144.
Guerrero Urbano, T.
Khoo, V.
Staffurth, J.
Norman, A.
Buffa, F.
Jackson, A.
Adams, E.
Hansen, V.
Clark, C.
Miles, E.
McNair, H.
Nutting, C.
Parker, C.
Eeles, R.
Huddart, R.
Horwich, A.
Dearnaley, D.P.
(2010). Intensity-modulated radiotherapy allows escalation of the radiation dose to the pelvic lymph nodes in patients with locally advanced prostate cancer: preliminary results of a phase I dose escalation study. Clin oncol (r coll radiol),
Vol.22
(3),
pp. 236-244.
show abstract
Pelvic irradiation in addition to prostate irradiation may improve outcome in locally advanced prostate cancer, but is associated with dose-limiting bowel toxicity. We report the preliminary results of a dose escalation study using intensity-modulated radiotherapy..
Bhide, S.A.
Davies, M.
Burke, K.
McNair, H.A.
Hansen, V.
Barbachano, Y.
El-Hariry, I.A.
Newbold, K.
Harrington, K.J.
Nutting, C.M.
(2010). Weekly Volume and Dosimetric Changes During Chemoradiotherapy With Intensity-Modulated Radiation Therapy for Head and Neck Cancer: A Prospective Observational Study. International journal of radiation oncology*biology*physics,
Vol.76
(5),
pp. 1360-1368.
Lalondrelle, S.
McNair, H.
Hansen, V.
Huddart, R.
Dearnaley, D.
Khoo, V.
(2009). The Clinical Implementation of Cone Beam CT (CBCT) Technology through Adaptive Radiotherapy Planning (ART). Clin oncol-uk,
Vol.21
(1),
pp. 67-67.
Lalondrelle, S.
Taylor, H.
McNair, H.
Hansen, V.N.
Huddart, R.
Khoo, V.
(2009). Steps to Clinical Implementation of Online Image Guided Adaptive Radiotherapy. Clinical oncology,
Vol.21
(3),
pp. 256-256.
Partridge, M.
Tree, A.
Brock, J.
McNair, H.
Fernandez, E.
Panakis, N.
Brada, M.
(2009). Improvement in tumour control probability with active breathing control and dose escalation: A modelling study. Radiotherapy and oncology,
Vol.91
(3),
pp. 325-329.
McNair, H.A.
Brock, J.
Symonds-Tayler, J.R.
Ashley, S.
Eagle, S.
Evans, P.M.
Kavanagh, A.
Panakis, N.
Brada, M.
(2009). Feasibility of the use of the Active Breathing Co ordinator™ (ABC) in patients receiving radical radiotherapy for non-small cell lung cancer (NSCLC). Radiotherapy and oncology,
Vol.93
(3),
pp. 424-429.
McNair, H.A.
Hansen, V.N.
Parker, C.C.
Evans, P.M.
Norman, A.
Miles, E.
Harris, E.J.
Del-Acroix, L.
Smith, E.
Keane, R.
Khoo, V.S.
Thompson, A.C.
Dearnaley, D.P.
(2008). A comparison of the use of bony anatomy and internal markers for offline verification and an evaluation of the potential benefit of online and offline verification protocols for prostate radiotherapy. Int j radiat oncol biol phys,
Vol.71
(1),
pp. 41-50.
show abstract
To evaluate the utility of intraprostatic markers in the treatment verification of prostate cancer radiotherapy. Specific aims were: to compare the effectiveness of offline correction protocols, either using gold markers or bony anatomy; to estimate the potential benefit of online correction protocol's using gold markers; to determine the presence and effect of intrafraction motion..
Bedford, J.L.
Nordmark Hansen, V.
McNair, H.A.
Aitken, A.H.
Brock, J.E.
Warrington, A.P.
Brada, M.
(2008). Treatment of lung cancer using volumetric modulated arc therapy and image guidance: A case study. Acta oncologica,
Vol.47
(7),
pp. 1438-1443.
Panakis, N.
McNair, H.A.
Christian, J.A.
Mendes, R.
Symonds-Tayler, J.R.
Knowles, C.
Evans, P.M.
Bedford, J.
Brada, M.
(2008). Defining the margins in the radical radiotherapy of non-small cell lung cancer (NSCLC) with active breathing control (ABC) and the effect on physical lung parameters. Radiotherapy and oncology,
Vol.87
(1),
pp. 65-73.
Mangar, S.A.
Miller, N.R.
Khoo, V.S.
Hansen, V.
McNair, H.
Horwich, A.
Huddart, R.A.
(2008). Evaluating Inter-fractional Changes in Volume and Position during Bladder Radiotherapy and the Effect of Volume Limitation as a Method of Reducing the Internal Margin of the Planning Target Volume. Clinical oncology,
Vol.20
(9),
pp. 698-704.
Mangar, S.A.
Miller, N.A.
Norman, A.
Hansen, V.
Foo, K.
McNair, H.
Horwich, A.
Huddart, R.A.
(2007). Evaluating the Impact of Volume Limitation as a Method of Reducing the Internal Margin of the PTV in Bladder Radiotherapy. Clinical oncology,
Vol.19
(3),
pp. S38-S39.
McNair, H.A.
Panakis, N.
Evans, P.
Brock, J.
Knowles, C.
Symonds-Tayler, J.R.
Brada, M.
(2007). Active Breathing Control (ABC) in Radical Radiotherapy of Non-small Cell Lung Cancer (NSCLC). Clinical oncology,
Vol.19
(3),
pp. S39-S39.
(2007). Gap analysis of role definition and training needs for therapeutic research radiographers in the UK. The british journal of radiology,
Vol.80
(957),
pp. 693-701.
Guerrero Urbano, T.
Clark, C.H.
Hansen, V.N.
Adams, E.J.
A'Hern, R.
Miles, E.A.
McNair, H.
Bidmead, M.
Warrington, A.P.
Dearnaley, D.P.
Harrington, K.J.
Nutting, C.M.
(2007). A phase I study of dose-escalated chemoradiation with accelerated intensity modulated radiotherapy in locally advanced head and neck cancer. Radiother oncol,
Vol.85
(1),
pp. 36-41.
show abstract
Intensity modulated radiotherapy (IMRT) allows the delivery of higher and more homogeneous radiation dose to head and neck tumours. This study aims to determine the safety of dose-escalated chemo-IMRT for larynx preservation in locally advanced head and neck cancer..
McNair, H.A.
Mangar, S.A.
Coffey, J.
Shoulders, B.
Hansen, V.N.
Norman, A.
Staffurth, J.
Sohaib, S.A.
Warrington, A.P.
Dearnaley, D.P.
(2006). A comparison of CT- and ultrasound-based imaging to localize the prostate for external beam radiotherapy. Int j radiat oncol biol phys,
Vol.65
(3),
pp. 678-687.
show abstract
This study assesses the accuracy of NOMOS B-mode acquisition and targeting system (BAT) compared with computed tomography (CT) in localizing the prostate..
O'Doherty, U.M.
McNair, H.A.
Norman, A.R.
Miles, E.
Hooper, S.
Davies, M.
Lincoln, N.
Balyckyi, J.
Childs, P.
Dearnaley, D.P.
Huddart, R.A.
(2006). Variability of bladder filling in patients receiving radical radiotherapy to the prostate. Radiother oncol,
Vol.79
(3),
pp. 335-340.
show abstract
Patients receiving radical radiotherapy to the prostate are requested to maintain a full bladder to displace the dome of the bladder and small bowel from the target volume. This study investigated patients' ability to consistently maintain a full bladder throughout planning and treatment before (Study 1) and after (Study 2) the introduction of a patient information sheet..
Harris, E.J.
McNair, H.A.
Evans, P.M.
(2006). Feasibility of fully automated detection of fiducial markers implanted into the prostate using electronic portal imaging: A comparison of methods. International journal of radiation oncology*biology*physics,
Vol.66
(4),
pp. 1263-1270.
Flampouri, S.
McNair, H.A.
Donovan, E.M.
Evans, P.M.
Partridge, M.
Verhaegen, F.
Nutting, C.M.
(2005). Initial patient imaging with an optimised radiotherapy beam for portal imaging. Radiotherapy and oncology,
Vol.76
(1),
pp. 63-71.
(2005). 997 ORAL Results of intensity modulated radiotherapy (IMRT) in laryngeal and hypopharyngeal cancer: A dose escalation study. European journal of cancer supplements,
Vol.3
(2),
pp. 287-287.
Christian, J.A.
Partridge, M.
Nioutsikou, E.
Cook, G.
McNair, H.A.
Cronin, B.
Courbon, F.
Bedford, J.L.
Brada, M.
(2005). The incorporation of SPECT functional lung imaging into inverse radiotherapy planning for non-small cell lung cancer. Radiotherapy and oncology,
Vol.77
(3),
pp. 271-277.
O'Sullivan, J.M.
Norman, A.R.
McNair, H.
Dearnaley, D.P.
(2004). Cranial nerve palsies in metastatic prostate cancer--results of base of skull radiotherapy. Radiother oncol,
Vol.70
(1),
pp. 87-90.
show abstract
We studied the rate of response to palliative external beam radiation therapy (20 Gy/5 or 30 Gy/10 fractions) to the base of skull in 32 prostate cancer patients with cranial nerve dysfunction. Sixteen patients (50%; 95% CI, 34-66%) had a useful response to therapy. The median survival post-therapy was 3 months..
Adams, E.J.
Convery, D.J.
Cosgrove, V.P.
McNair, H.A.
Staffurth, J.N.
Vaarkamp, J.
Nutting, C.M.
Warrington, A.P.
Webb, S.
Balyckyi, J.
Dearnaley, D.P.
(2004). Clinical implementation of dynamic and step-and-shoot IMRT to treat prostate cancer with high risk of pelvic lymph node involvement. Radiother oncol,
Vol.70
(1),
pp. 1-10.
show abstract
Two systems have been developed for treating patients with locally advanced prostate cancer using intensity-modulated radiotherapy (IMRT): one using dynamic multi-leaf collimator delivery and the other using step-and-shoot. This paper describes the clinical implementation of these two techniques, and presents results from the first 14 patients treated in a clinical setting (nine dynamic, five step-and-shoot)..
McNair, H.A.
Parker, C.
Hansen, V.N.
Askew, L.
Mukherjee, R.
Nutting, C.
Norman, A.R.
Dearnaley, D.P.
(2004). An evaluation of Beam cath in the verification process for prostate cancer radiotherapy. Clin oncol (r coll radiol),
Vol.16
(2),
pp. 138-147.
show abstract
As the trend towards more conformal treatment continues, the accuracy of treatment delivery becomes more important. Conventionally, treatment set-up for prostate cancer patients is verified in relation to the bony anatomy. However, there can be prostate movement independent of bony anatomy. This study tested the feasibility of using Beam cath to enable online correction of treatment set-up in relation to the prostate position, and to assess inter-fraction and intra-fraction prostate movement..
McNair, H.A.
Francis, G.
Balyckyi, J.
(2004). Clinical implementation of dynamic intensity-modulated radiotherapy: radiographers' perspectives. The british journal of radiology,
Vol.77
(918),
pp. 493-498.
Lee, Y.
(2003). Radiotherapy treatment planning of prostate cancer using magnetic resonance imaging alone. Radiotherapy and oncology,
Vol.66
(2),
pp. 203-216.
McNair, H.A.
Selous-Hodges, J.
Convery, D.
Cosgrove, V.
Balyckyi, J.
Dearnaley, D.P.
Nuttings, C.
(2003). Clinical implementation of intensity modulated radiotherapy: initial experiences. Journal of radiotherapy in practice,
Vol.3
(2),
pp. 63-67.
show abstract
The development of intensity modulated radiotherapy (IMRT) has allowed the delivery of concave dose distributions. Planning studies have demonstrated the potential clinical benefit of IMRT in the treatment of the prostate and pelvic nodes in patients with advanced prostate cancer. As a consequence, IMRT was clinically implemented in the Royal Marsden NHS Trust in September 2000, using Elekta Sli series linear accelerators and NOMOS Corvus v3.0 planning system. As a relatively new treatment procedure in the United Kingdom, the clinical implementation involved developing appropriate quality assurance and verification procedures as well as training staff. This paper describes the practicalities of implementing IMRT into the routine workload of the radiotherapy department..
Bollet, M.A.
McNair, H.A.
Hansen, V.N.
Norman, A.
O'Doherty, U.
Taylor, H.
Rose, M.
Mukherjee, R.
Huddart, R.
(2003). Can digitally reconstructed radiographs (DRRS) replace simulation films in prostate cancer conformal radiotherapy?. International journal of radiation oncology*biology*physics,
Vol.57
(4),
pp. 1122-1130.
McNair, H.A.
Adams, E.J.
Clark, C.H.
Miles, E.A.
Nutting, C.M.
(2003). Implementation of IMRT in the radiotherapy department. The british journal of radiology,
Vol.76
(912),
pp. 850-856.
Nutting, C.M.
Khoo, V.S.
Walker, V.
McNair, H.
Beardmore, C.
Norman, A.
Dearnaley, D.P.
(2000). A randomized study of the use of a customized immobilization system in the treatment of prostate cancer with conformal radiotherapy. Radiother oncol,
Vol.54
(1),
pp. 1-9.
show abstract
To evaluate the impact of a customized immobilisation system on field placement accuracy, simulation and treatment delivery time, radiographer convenience and patient acceptability..
Jalali,
Brada,
Perks,
Warrington,
Traish,
Burchell,
McNair,
Thomas,
Robinson,
Johnston,
(2000). Stereotactic conformal radiotherapy for pituitary adenomas: technique and preliminary experience. Clinical endocrinology,
Vol.52
(6),
pp. 695-702.
Bartlett, F.R.
Colgan, R.M.
Donovan, E.M.
Carr, K.
Landeg, S.
Clements, N.
McNair, H.A.
Locke, I.
Evans, P.M.
Haviland, J.S.
Yarnold, J.R.
Kirby, A.M.
Voluntary Breath-hold Technique for Reducing Heart Dose in Left Breast Radiotherapy. Journal of visualized experiments,
(89).
Dearnaley, D.
Murray, J.
McNair, H.
Rationale and development of image-guided intensity-modulated radiotherapy post-prostatectomy: the present standard of care?. Cancer management and research,
,
pp. 331-331.
Alexander, S.E.
Kinsella, J.
McNair, H.A.
Tree, A.C.
National survey of fiducial marker insertion for prostate image guided radiotherapy. Radiography (london, england : 1995),
Vol.24
(4),
pp. 275-282.
show abstract
Introduction In the United Kingdom fiducial marker IGRT is the second most common verification method employed in radical prostate radiotherapy yet little evidence exists to support centres introducing or developing this practice. We developed a survey to elicit current fiducial marker practices adopted in the UK, to recommend standardisation of practice.Methods A 16 question survey was distributed across UK Radiotherapy centres via promotion at the British Uro-Oncology Group Conference, 2016. Included were questions relating to workforce planning, patient preparation, insertion procedure and verification methods. The survey was open from September 2016 to January 2017.Results Results from 15 centres routinely inserting fiducial markers for prostate IGRT are presented. Eleven professional groups insert fiducial markers across the UK. Fourteen centres insert fiducial markers trans-rectally; one trans-perineally. Centres adopting a trans-rectal approach administer prophylactic ciprofloxacin as a single agent or combined with gentamicin or metronidazole; poor agreement between regimes presented. One centre has introduced targeted antibiotic prophylaxis. Five brands of fiducial markers are utilised nationally. Fourteen centres standardly insert three single fiducial markers, two common configurations emerged. Coupled fiducial markers are routinely implanted by one centre. All centres delay at least one week between fiducial marker insertion and planning CT; seven centres wait two weeks. The most common fiducial verification method is two-dimensional, paired kilo Voltage imaging.Conclusion Variation in fiducial marker practice across the UK is considerable. Standardisation is required to support centres and healthcare professionals developing this service. Seven recommendations, to unify practice, have been proposed based on survey results and literature..
Beasley, M.
Brown, S.
McNair, H.
Faivre-Finn, C.
Franks, K.
Murray, L.
van Herk, M.
Henry, A.
The advanced radiotherapy network (ART-NET) UK lung stereotactic ablative radiotherapy survey: national provision and a focus on image guidance. The british journal of radiology,
,
pp. 20180988-20180988.
Gani, C.
Boeke, S.
McNair, H.
Ehlers, J.
Nachbar, M.
Mönnich, D.
Stolte, A.
Boldt, J.
Marks, C.
Winter, J.
Künzel, L.A.
Gatidis, S.
Bitzer, M.
Thorwarth, D.
Zips, D.
Marker-less online MR-guided stereotactic body radiotherapy of liver metastases at a 1 5 T MR-Linac - Feasibility, workflow data and patient acceptance. Clinical and translational radiation oncology,
Vol.26,
pp. 55-61.
show abstract
Introduction Stereotactic body radiotherapy (SBRT) is an established ablative treatment for liver tumors with excellent local control rates. Magnetic resonance imaging guided radiotherapy (MRgRT) provides superior soft tissue contrast and may therefore facilitate a marker-less liver SBRT workflow. The goal of the present study was to investigate feasibility, workflow parameters, toxicity and patient acceptance of MRgSBRT on a 1.5 T MR-Linac.Methods Ten consecutive patients with liver metastases treated on a 1.5 T MR-Linac were included in this prospective trial. Tumor delineation was performed on four-dimensional computed tomography scans and both exhale triggered and free-breathing T2 MRI scans from the MR-Linac. An internal target volume based approach was applied. Organ at risk constraints were based on the UKSABR guidelines (Version 6.1). Patient acceptance regarding device specific aspects was assessed and toxicity was scored according to the common toxicity criteria of adverse events, version 5.Results Nine of ten tumors were clearly visible on the 1.5 T MR-Linac. No patient had fiducial markers placed for treatment. All patients were treated with three or five fractions. Median dose to 98% of the gross tumor volume was 38.5 Gy. The median time from "patient identity check" until "beam-off" was 31 min. Median beam on time was 9.6 min. Online MRgRT was well accepted in general and no treatment had to be interrupted on patient request. No event of symptomatic radiation induced liver disease was observed after a median follow-up of ten month (range 3-17 months).Conclusion Our early experience suggests that online 1.5 T MRgSBRT of liver metastases represents a promising new non-invasive marker-free treatment modality based on high image quality, clinically reasonable in-room times and high patient acceptance. Further studies are necessary to assess clinical outcome, to validate advanced motion management and to explore the benefit of online response adaptive liver SBRT..
Edmunds, D.
Gothard, L.
Khabra, K.
Kirby, A.
Madhale, P.
McNair, H.
Roberts, D.
Symonds-Tayler, R.
Donovan, E.
Low-cost Kinect Version 2 imaging system for breath hold monitoring and gating: Proof of concept study for breast cancer VMAT radiotherapy. Journal of applied clinical medical physics,
.
Barnes, H.
Alexander, S.
Bower, L.
Ehlers, J.
Gani, C.
Herbert, T.
Lawes, R.
Møller, P.K.
Morgan, T.
Nowee, M.E.
Smith, G.
van Triest, B.
Tyagi, N.
Whiteside, L.
McNair, H.
Development and results of a patient-reported treatment experience questionnaire on a 1 5 T MR-Linac. Clinical and translational radiation oncology,
Vol.30,
pp. 31-37.
show abstract
Introduction With the implementation of new radiotherapy technology, it is imperative that patient experience is investigated alongside efficacy and outcomes. This paper presents the development of a specifically designed validated questionnaire and a first report of international multi-institutional preliminary patient experience of MRI-guided adaptive radiotherapy (MRgART) on the 1.5 T MR-Linac (MRL). Methods A patient experience questionnaire was developed and validated before being distributed to the Elekta MRL Consortium, to gather first patient-reported experience from participating centres worldwide. The final version of the questionnaire contains 18 questions covering a range of themes and was scored on a Likert scale of 0-3. Responses were post-processed so that a score of 0 represents a negative response and 3 represents the most favourable response. These results were analysed for patient-reported experience of treatment on the MRL. Results were also analysed for internal consistency of the questionnaire using Chronbach's Alpha and the questionnaire contents were validated for relevance using content validity indexes (CVI). Results 170 responses were received from five centres, representing patients with a wide range of tumour treatment sites from four different countries. MRgART was well tolerated with an 84% favourable response across all questions and respondents. When analysed by theme, all reported the highest percentage of results in the favourable categories (2 and 3). Internal consistency in the questionnaire was high (Cronbach's α = 0.8) and the item-level CVI for each question was 0.78 or above and the Scale-level CVI was 0.93, representing relevant content. Conclusion The developed questionnaire has been validated as relevant and appropriate for use in reporting experience of patients undergoing treatment on the MRL. The overall patient-reported experience and satisfaction from multiple centres within the Elekta MRL Consortium was consistently high. These results can reinforce user confidence in continuing to expand and develop MRL use in adaptive radiotherapy..
Ranger, A.
Dunlop, A.
Grimwood, A.
Durie, E.
Donovan, E.
Havilland, J.
Harris, E.
McNair, H.
Kirby, A.M.
Voluntary versus ABC breath-hold in the context of VMAT for breast and locoregional lymph node radiotherapy including the internal mammary chain. Clinical and translational radiation oncology,
Vol.27,
pp. 164-168.
show abstract
Background Deep-inspiration breath-hold (DIBH) reduces radiation dose to the heart in patients undergoing locoregional breast radiotherapy. In the context of tangential irradiation of the breast/ chest wall, a voluntary breath hold (vDIBH) technique has been shown to be as reproducible as a machine-assisted breath hold technique using the active breathing co-ordinator (ABC™, Elekta, Crawley, UK, ABC_DIBH). This study compares set-up reproducibility for vDIBH versus ABC_DIBH in patients undergoing volumetric-modulated arc radiotherapy (VMAT) for breast cancer, both with and without wax bolus.Method Patients with breast cancer requiring pan regional lymph node VMAT +/- wax bolus in breath-hold were CT scanned in vDIBH and ABC_DIBH. Patients were randomised to receive one technique for fractions 1-7 and the other for fractions 8-15. Daily cone beam computed tomography (CBCT) was performed and registered to planning-CT using bony anatomy. Within-patient comparisons of mean daily chest wall position were made using a paired t -test. Population, systematic (∑) and random errors (α) were estimated. Intrafraction reproducibility was assessed by comparing chest wall position and diaphragm movement between consecutive breath holds on CBCT.Results 16 patients were recruited. All completed treatment with both techniques (9 patients with wax bolus, 7 patients without). CBCT derived ∑ were 2.1-6.4 mm (ABC_DIBH) and 2.1-4.9 mm (vDIBH), α were 1.7-2.6 mm (ABC_DIBH) and 2.2-2.7 mm (vDIBH) and mean daily chest wall displacements (MD) were 0.0-1.5 mm (ABC_DIBH) and - 0.1-1.6 vDIBH (all p non-significant). Chest wall and diaphragm position was equivalent between consecutive breath holds in ABC and vDIBH (median difference 1.0 mm and 0.8 mm respectively, non p significant) demonstrating equivalent intrafraction reproducibility.Conclusion This study demonstrates that a simple voluntary breath hold technique is feasible in combination with VMAT (+/- bolus) and is as reproducible as ABC_DIBH with VMAT for the irradiation of the breast and axillary and IMC lymph nodes in breast cancer patients..
Hall, E.
Hafeez, S.
Lewis, R.
Huddart, R.
Advancing radiotherapy for bladder cancer: Randomised phase II trial of adaptive image guided standard or dose escalated tumour boost radiotherapy (RAIDER). Clinical oncology,
.
Grimwood, A.
Thomas, K.
Kember, S.
Aldis, G.
Lawes, R.
Brigden, B.
Francis, J.
Henegan, E.
Kerner, M.
Delacroix, L.
Gordon, A.
Tree, A.
Harris, E.J.
McNair, H.A.
Factors affecting accuracy and precision in ultrasound guided radiotherapy. Physics and imaging in radiation oncology,
Vol.18,
pp. 68-77.
show abstract
Background and purpose
Transperineal ultrasound (TPUS) is used clinically for directly assessing prostate motion. Factors affecting accuracy and precision in TPUS motion estimation must be assessed to realise its full potential.
Methods and materials
Patients were imaged using volumetric TPUS during the Clarity-Pro trial (NCT02388308). Prostate motion was measured online at patient set-up and offline by experienced observers. Cone beam CT with markers was used as a comparator and observer performance was also quantified. The influence of different clinical factors was examined to establish specific recommendations towards efficacious ultrasound guided radiotherapy.
Results
From 330 fractions in 22 patients, offline observer random errors were 1.5 mm, 1.3 mm, 1.9 mm (left-right, superior-inferior, anteroposterior respectively). Errors increased in fractions exhibiting poor image quality to 3.3 mm, 3.3 mm and 6.8 mm. Poor image quality was associated with inconsistent probe placement, large anatomical changes and unfavourable imaging conditions within the patient. Online matching exhibited increased observer errors of: 3.2 mm, 2.9 mm and 4.7 mm. Four patients exhibited large systematic residual errors, of which three had poor quality images. Patient habitus showed no correlation with observer error, residual error, or image quality.
Conclusions
TPUS offers the unique potential to directly assess inter- and intra-fraction motion on conventional linacs. Inconsistent image quality, inexperienced operators and the pressures of the clinical environment may degrade precision and accuracy. Experienced operators are essential and cross-centre standards for training and QA should be established that build upon current guidance. Greater use of automation technologies may further minimise uncertainties..