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

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

Introduction: Radiation therapy has a highly complex pathway and uses detailed quality assurance protocols and incident learning systems (ILSs) to mitigate risk; however, errors can still occur. The safety culture (SC) in a department influences its commitment and effectiveness in maintaining patient safety.Methods: Perceptions of SC and knowledge and understanding of ILSs and their use were evaluated for radiation oncology staff across Australia and New Zealand (ANZ). A validated healthcare survey tool (the Hospital Survey on Patient Safety Culture) was used, with additional specialty-focussed supporting questions. A total of 220 radiation oncologists, radiation therapists and radiation oncology medical physicists participated.Results: An overall positive SC was indicated, with strength in teamwork (83.7%), supervisor/manager/leader support (83.3%) and reporting events (77.1%). The weakest areas related to communication about error (63.9%), hospital-level management support (60.5%) and handovers and information exchange (58.0%). Barriers to ILS use included 'it takes too long' and that many respondents must use multiple reporting systems, including mandatory hospital-level systems. These are generally not optimal for specific radiation oncology needs. Varied understanding was indicated of what and when to report.Conclusion: The findings report the ANZ perspective on ILS and SC, highlighting weaknesses, barriers and areas for further investigation. Differences observed in some areas suggest that a unified state, national or bi-national ILS specific to radiation oncology might eliminate multiple reporting systems and reduce reporting time. It could also provide more consistent and robust approaches to incident reporting, information sharing and analysis. [ABSTRACT FROM AUTHOR]

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

Introduction: Regular tumour‐specific peer review meetings (TPRMs) were established by our group during 2016. A dedicated Quality Assurance Radiation Therapist (QART) was employed in 2018 to co‐ordinate the meetings and for each patient, complete the Peer Review Audit Tool (PRAT) of the Royal Australian and New Zealand College of Radiologists (RANZCR). The aim of the current quality assurance study was to investigate the impact of the TPRMs and appointment of the QART on compliance to relevant RANZCR Radiation Oncology Practice Standards (ROPS). Methods: Tumour‐specific peer review meetings for eight tumour sites were assessed across our group's three hospitals from January 2017 to December 2019. Data from meetings were collected using the PRAT or from paper‐based minutes and assessed against four ROPS (ROPS 3, 4, 8 and 9). Compliance with each of the four standards was measured by presence of the required documentation and presentation at TPRM, as recorded by the PRAT. Results: There was an increase in the overall number of peer review cases audited from 173 in the 2017 calendar year to 469 in 2018 and 619 in 2019, representing 7%, 18% and 22% of all treatment courses started during these years, respectively. Staging was the most incompletely documented item across all years for audited patients. The request for radiation treatment plan modifications increased year‐on‐year: modifications were requested for 5% of plans in 2017 (8/172), 18% in 2018 (81/452) and 19% (119/619) in 2019. Conclusion: This study has shown that an increase in the number of cases for peer‐review audit corresponded to the QART‐facilitated TPRMs. Application of the PRAT has identified radiation treatment plan modifications that would otherwise go undetected and without opportunity to improve the quality of patients' treatment or avoid harm. [ABSTRACT FROM AUTHOR]

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

Aim: The aim of this study was to determine dosimetric factors, such as mean dose and oesophageal length, which may influence the incidence and severity of oesophagitis in breast cancer patients receiving radiotherapy to the supraclavicular nodes.Methods: This was a single-arm prospective observational study. Toxicity grading was undertaken twice weekly to determine the onset of grade 2 oesophagitis in consecutive patients prescribed IMRT to the breast or chest wall and supraclavicular fossa (SCF) nodes. Recorded variables included mean and maximum doses to the oesophagus, oesophageal length and pharynx length within the treatment area. Multivariate logistic regression and Fishers' exact test were used with a 0.05 significance level to compare the onset of grade 2 oesophagitis with these variables.Results: A total of 77 patients were included in the study. Twenty-four (31%) patients reported grade 2 oesophagitis. There was a higher incidence of grade 2 oesophagitis in patients receiving a mean oesophageal dose of ≥31 Gy compared to those receiving < 31 Gy (18/24 versus 6/24, respectively, P = 0.025). There was a significant difference in the onset of grade 2 toxicity in patients who had ≥ 1 cm of pharynx included in SCF fields compared with those with <1 cm (15/24 versus 9/24, respectively, P = 0.0116). The odds ratios for developing grade 2 oesophagitis were 3.2 (95% CI = 1.05-9.62, P = 0.04) for a mean dose of ≥31 Gy and 3.4 (95% CI = 1.19-9.5, P = 0.022) for ≥1 cm of pharynx in the SCF field.Conclusion: By limiting the mean dose to the irradiated oesophagus to <31 Gy during the planning process and ensuring that <1 cm of pharynx is included in the radiation field, oesophageal toxicity may be minimised. [ABSTRACT FROM AUTHOR]

Objective: To explore the relative frequency of a family history of cholesteatoma in patients with known cholesteatoma, and whether bilateral disease or earlier diagnosis is more likely in those with a family history. Associations between cleft lip or palate and bilateral disease and age of diagnosis were also explored. Design: An online survey of patients with diagnosed cholesteatoma was conducted between October 2017 and April 2019. Participants: The sample consisted of patients recruited from two UK clinics and self‐selected respondents recruited internationally via social media. Main outcome measures: Side of cholesteatoma, whether respondents had any family history of cholesteatoma, age of diagnosis and personal or family history of cleft lip or palate were recorded. Results: Of 857 respondents, 89 (10.4%) reported a positive family history of cholesteatoma. Respondents with a family history of cholesteatoma were more likely to have bilateral cholesteatoma (P =.001, odds ratio (OR) 2.15, 95% confidence interval (CI) 1.35‐3.43), but there was no difference in the age of diagnosis (P =.23). Those with a history of cleft lip or palate were not more likely to have bilateral disease (P =.051, OR 2.71, CI 1.00‐7.38), and there was no difference in age of diagnosis (P =.11). Conclusion: The relatively high proportion of respondents that reported a family history of cholesteatoma offers supporting evidence of heritability in cholesteatoma. The use of social media to recruit respondents to this survey means that the results cannot be generalised to other populations with cholesteatoma. Further population‐based research is suggested to determine the heritability of cholesteatoma. [ABSTRACT FROM AUTHOR]

Urethral carcinoma is a rare urological cancer, accounting for only 1% of malignancies in Australia. The most common histology is transitional cell carcinoma (TCC). The majority of these cancers are treated with surgery. The main purpose of this case study is to describe a novel radiation treatment technique for treatment of this uncommon cancer. This report details organ‐preserving treatment for a distal penile urethral cancer using definitive radiation therapy (RT). In May 2016 a 69‐year‐old male presented to Crown Princess Mary Cancer Centre (CPMCC) with a small TCC of the distal urethra. The patient was offered numerous treatment options, both radical and organ‐preserving approaches, and came to a final decision of a course of radiation therapy despite the lack of randomised evidence to guide treatment in this setting. A dose of 66 Gy in 33 fractions from parallel opposed lateral beams was prescribed to the distal penile urethra. This case required an unusual approach to patient set up to allow access for accurate treatment delivery and to maintain patient comfort. The patient tolerated the full course of radiation therapy with expected skin side effects. He has maintained adequate penile function and is currently free from disease at 33 months with ongoing clinical follow‐up. [ABSTRACT FROM AUTHOR]

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

This focus article has been prepared by Suzi Bell, Amanda Carson, Rachael Collins, Lizzy Dunnett, Rudolf Reichel and Moyna Richey of the APHA Small Ruminant Expert Group. [ABSTRACT FROM AUTHOR]

The article reports on the detection of a multidrug resistant (MDR) Salmonella Paratyphi B variant Java (MDRS Java) in two broilers from England in the late 2012. It notes on the potential sources for transmission of different clonal lines of the bacterial strains including animal feeds, fish or seafood imported from the Far East and European poultry products from the continent. It suggests that the case was likely an imported infection, based on the results of epidemiological investigations.