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Copyright of Journal of Medical Imaging & Radiation Sciences is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

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. [ABSTRACT FROM AUTHOR]

Purpose To compare mean heart and left anterior descending coronary artery (LAD) doses (NTD mean ) and positional reproducibility in larger-breasted women receiving left breast radiotherapy using supine voluntary deep-inspiratory breath-hold (VBH) and free-breathing prone techniques. Materials and methods Following surgery for early breast cancer, patients with estimated breast volumes >750 cm 3 underwent planning-CT scans in supine VBH and free-breathing prone positions. Radiotherapy treatment plans were prepared, and mean heart and LAD doses were calculated. Patients were randomised to receive one technique for fractions 1–7, before switching techniques for fractions 8–15 (40 Gy/15 fractions total). Daily electronic portal imaging and alternate-day cone-beam CT (CBCT) imaging were performed. The primary endpoint was the difference in mean LAD NTD mean between techniques. Population systematic ( Σ ) and random errors ( σ ) were estimated. Within-patient comparisons between techniques used Wilcoxon signed-rank tests. Results 34 patients were recruited, with complete dosimetric data available for 28. Mean heart and LAD NTD mean doses for VBH and prone treatments respectively were 0.4 and 0.7 ( p < 0.001) and 2.9 and 7.8 ( p < 0.001). Clip-based CBCT errors for VBH and prone respectively were ⩽3.0 mm and ⩽6.5 mm ( Σ ) and ⩽3.5 mm and ⩽5.4 mm ( σ ). Conclusions In larger-breasted women, supine VBH provided superior cardiac sparing and reproducibility than a free-breathing prone position. [ABSTRACT FROM AUTHOR]

Purpose: To determine whether voluntary deep-inspiratory breath-hold (v_DIBH) and deep-inspiratory breath-hold with the active breathing coordinator™ (ABC_DIBH) in patients undergoing left breast radiotherapy are comparable in terms of normal-tissue sparing, positional reproducibility and feasibility of delivery. Methods: Following surgery for early breast cancer, patients underwent planning-CT scans in v_DIBH and ABC_DIBH. Patients were randomised to receive one technique for fractions 1–7 and the second technique for fractions 8–15 (40Gy/15 fractions total). Daily electronic portal imaging (EPI) was performed and matched to digitally-reconstructed radiographs. Cone-beam CT (CBCT) images were acquired for 6/15 fractions and matched to planning-CT data. Population systematic (Σ) and random errors (σ) were estimated. Heart, left-anterior-descending coronary artery, and lung doses were calculated. Patient comfort, radiographer satisfaction and scanning/treatment times were recorded. Within-patient comparisons between the two techniques used the paired t-test or Wilcoxon signed-rank test. Results: Twenty-three patients were recruited. All completed treatment with both techniques. EPI-derived Σ were ⩽1.8mm (v_DIBH) and ⩽2.0mm (ABC_DIBH) and σ ⩽2.5mm (v_DIBH) and ⩽2.2mm (ABC_DIBH) (all p non-significant). CBCT-derived Σ were ⩽3.9mm (v_DIBH) and ⩽4.9mm (ABC_DIBH) and σ ⩽4.1mm (v_DIBH) and ⩽3.8mm (ABC_DIBH). There was no significant difference between techniques in terms of normal-tissue doses (all p non-significant). Patients and radiographers preferred v_DIBH (p =0.007, p =0.03, respectively). Scanning/treatment setup times were shorter for v_DIBH (p =0.02, p =0.04, respectively). Conclusions: v_DIBH and ABC_DIBH are comparable in terms of positional reproducibility and normal tissue sparing. v_DIBH is preferred by patients and radiographers, takes less time to deliver, and is cheaper than ABC_DIBH. [ABSTRACT FROM AUTHOR]

Introduction: There is little research regarding the experiences of patient comfort and how it is best managed in radiotherapy. The aim of this study was to explore the experiences of patient and therapeutic radiographer views of comfort during radiotherapy., Methods: This qualitative study involved semi-structured interviews, with cancer patients (n = 25) and therapeutic radiographers (n = 25), conducted between January-July 2019. Patients were recruited from one radiotherapy clinic and therapeutic radiographers were recruited from across the United Kingdom via specialist interest groups and social media. Interviews were audio-recorded and transcribed verbatim. Thematic analysis was used to analyse the data separately between both groups and shared themes were identified., Results: Four themes were identified of which two themes were shared among both the patients and therapeutic radiographer. Emotional Health was a shared theme highlighting experiences such as stress, vulnerability and privacy. The second shared theme, Positioning and Immobilisation Experiences, concerned how patients' experience being physically positioned and using immobilisation for accurate radiotherapy. The theme Information and Communication Experience was derived from patients highlighting concerns over sharing and provision of information and ways of communication. The last theme, Environmental Experience, emerged from the patient interviews and related to the first impressions of the radiotherapy environment such as reception or treatment rooms and how this effects the overall feelings of comfort., Conclusion: This qualitative study has provided the shared voice of patients and therapeutic radiographers and their experiences of comfort during radiotherapy. These shared experiences emphasise the importance of considering comfort holistically and not just from a physical context. This information can be used by therapeutic radiographers to better understand their patients experiences and needs to provide better comfort during radiotherapy to improve patients' outcomes., Implications for Practice: The clinical implications of our study can encourage Therapeutic Radiographers to provide holistic care for their patients throughout the pathway and specifically to comfort patients while they are having treatment. In the short term this could be via simple adaptions to practice while in the long term, research is needed to develop comfort interventions for patients receiving radiotherapy., Competing Interests: Conflict of interest None., (Copyright © 2023 The College of Radiographers. Published by Elsevier Ltd. All rights reserved.)

Objective: Stereotactic ablative radiotherapy (SABR) has become the standard of care for suitable patients with peripherally located early stage non-small cell lung cancer. Lung SABR requires strict image-guided radiotherapy (IGRT) protocols to ensure its safe delivery. The aim of this survey was to provide an assessment of current lung SABR practice in the UK., Methods: An online semi-structured survey containing a maximum of 32 questions regarding lung SABR, focussing on treatment image verification processes was piloted, developed and disseminated to the radiotherapy managers of 62 National Health Service centres across the UK., Results: The survey had a 100% complete response from NHS centres. 36 centres (58%) currently deliver lung SABR, with half treating fewer than 50 patients per year. Six centres deliver SABR despite not being commissioned by the NHS to provide this service. There is wide variation in the use of IGRT. Eight different permutations of cone beam CT order within the workflow were reported. Almost half of lung centres (17/36, 47%) believe there is a need to update national image guidance associated with lung SABR, such as the use of 'day zero', mid treatment and post treatment cone beam CTs., Conclusion: Our results demonstrate wide variation in IGRT for lung SABR. There is an opportunity to develop existing IGRT workflows and the optimal approach to image guidance. Further work is required to investigate lung SABR provision and potential barriers to its implementation., Advances in Knowledge: This survey represents the most comprehensive and accurate assessment of lung SABR practice in the UK since the 2014 SABR consortium survey.