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W Wielkopolskim Centrum Onkologii od dwudziestu pięciu lat stosuje się metodę napromieniania całego ciała (ang. Total Body Irradiation, TBI) jako metodę przygotowania pacjentów przed przeszczepem szpiku. Aktualnie stosowana procedura zakłada dawkę 12 Gy z obniżeniem dawki na płuca do 9 Gy. Pacjent jest napromieniany z pól lateralnych oraz AP/PA. Duża dawka, na którą narażony jest pacjent ma wpływ nie tylko na komórki nowotworowe, ale również na zdrowe narządy i prowadzi do licznych zmian popromiennych.

Penile cancer is a rarely diagnosed cancer that affects 0.4%-0.6% of all male population. Metastases to the bones from various human cancers are common; however, acrometastases are extremely rare with the most common primary tumor from lung, kidney, and breast. We report the first case of a patient with acrometastases to the left wrist reported from penile cancer.

To assess adherence to standard clinical practice for the diagnosis and treatment of patients undergoing prostate cancer (PCa) radiotherapy in four European countries using clinical audits as part of the international IROCA project. Multi-institutional, retrospective cohort study of 240 randomly-selected patients treated for PCa (n = 40/centre) in the year 2015 at six European hospitals. Clinical indicators applicable to general and PCa-specific radiotherapy processes were evaluated. All data were obtained directly from medical records. The audits were performed in the year 2017. Adherence to clinical protocols and practices was satisfactory, but with substantial inter-centre variability in numerous variables, as follows: staging MRI (range 27.5–87.5% of cases); presentation to multidisciplinary tumour board (2.5–100%); time elapsed between initial visit to the radiation oncology department and treatment initiation (42–102.5 days); number of treatment interruptions ≥ 1 day (7.5–97.5%). The most common deviation from standard clinical practice was inconsistent data registration, mainly failure to report data related to diagnosis, treatment, and/or adverse events. This clinical audit detected substantial inter-centre variability in adherence to standard clinical practice, most notably inconsistent record keeping. These findings confirm the value of performing clinical audits to detect deviations from standard clinical practices and procedures.

Background The calculation and measurement on the surface of the skin presents a significant dosimetric problem because of numerous factors which have an influence on the dose distribution in this region. Aim The overall aim of this study was to check the agreement between doses measured with thermoluminescent detectors (TLD) during tomotherapy photon beam irradiation of the skin area of a solid water cylindrical phantom with doses calculated with Hi-Art treatment planning system (TPS). Material and Method The measurements of the dose were made with the use of a solid water cylindrical phantom - Cheese Phantom. Two bolus phantoms were used: 5 mm and 10 mm Six different planning treatments were generated. The doses were measured using TL detectors. Results In the case of a tumor located near the surface of the skin, the mean dose for 0.5 cm bolus was - 1.94 Gy, and for 1 cm bolus - 2.03 Gy. For the tumor located inside the phantom and organ at risk on the same side that TL detectors, for a 0.5 cm bolus, mean dose was 0.658 Gy, and for a 1 cm bolus, 0.62 Gy. Conclusion The analysis of results showed that the relative percentage difference between measured and planned dose in the field of irradiation was less than 10%, while the largest differences were on the board of the field of radiation and outside of the field of irradiation, where the dose was 0.08 Gy to 1 Gy.

Purpose To perform a clinical audit to assess adherence to standard clinical practice for the diagnosis, treatment, and follow-up of patients undergoing radiotherapy for rectal cancer treatment in four European countries. Materials and methods Multi-institutional, retrospective cohort study of 221 patients treated for rectal cancer in 2015 at six European cancer centres. Clinical indicators applicable to general radiotherapy processes were evaluated. All data were obtained from electronic medical records. Results The audits were performed in the year 2017. We found substantial inter-centre variability in adherence to standard clinical practices: 1) presentation of cases at departmental clinical sessions (range, 0–100%) or multidisciplinary tumour board (50–95%); 2) pretreatment MRI (61.5–100%) and thoracoabdominal CT (15.0–100%). Large inter-centre differences were observed in the mean interval between biopsy and first visit to the radiotherapy department (range, 21.6–58.6 days) and between the first visit and start of treatment (15.1–38.8 days). Treatment interruptions ≥ 1 day occurred in 43.9% (2.5–90%) of cases overall. Treatment compensation was performed in 2.1% of cases. Treatment was completed in the prescribed time in 55.7% of cases. Conclusions This multi-institutional clinical audit revealed that most centres adhered to standard clinical practices for most of the radiotherapy processes-related variables assessed. However, the audit revealed marked inter-centre variability for certain quality indicators, particularly inconsistent record keeping. Multiple targets for improvement and/or harmonisation were identified, confirming the value of routine clinical audits to detect potential deviations from standard clinical practice.

Celem niniejszego artykułu jest przedstawienie niektórych działań Międzynarodowej Agencji Energii Atomowej oraz Światowej Organizacji Zdrowia związanych z audytami klinicznymi, które przyczyniają się do bezpiecznej i skutecznej realizacji radioterapii.Od ponad 30 lat Międzynarodowa Agencja Energii Atomowej (ang. International Atomic Energy Agency, IAEA) prowadzi wiele projektów mających na celu podniesienie jakości, bezpieczeństwa, a także dostępu do radioterapii na całym świecie. IAEA wspiera rozwój i normalizację w zakresie dozymetrii promieniowania oraz dostarczania usług dozymetrycznych państwom o niskich i średnich dochodach, co przyczynia się do ujednolicenia procedur dozymetrycznych na całym świecie. IAEA oferuje wspólną i jednolitą metodologię audytów dozymetrycznych opartych na detektorach termoluminescencyjnych, przekazuje wytyczne i zapewnia zaplecze techniczne dla krajowych sieci audytujących ośrodki radioterapii.

The number of patients with cardiac implantable electronic devices (CIED), who require oncological management including radiotherapy (RT) is still increasing. According to current knowledge the most frequent device dysfunction related to exposition to ionizing radiation is reprogramming to emergency mode (soft reset). There are uncommon cases of complete, irreversible device damage. CIED dysfunction during RT can be observed in approximately 3% of patients. In majority of cases they are asymptomatic, although in literature there are descriptions of deterioration of clinical status due to bradycardia or exacerbation of heart failure. The most important factor of device malfunction is radiotherapy with photons of energy >10 MV or protons despite energy used. So far there were no cases published with inadequate ICD therapies due to the presence of electromagnetic field interference during RT. Because patients with CIED undergoing RT need complex care to achieve high level of safety, experts of Heart Rhythm Society establish document, published in 2017 which summarized current knowledge about this group of patients. The document contains guidelines on peri-radiotherapy care of patients with CIED.

As radiotherapy practice and processes become more complex, the need to assure quality control becomes ever greater. At present, no international consensus exists with regards to the optimal quality control indicators for radiotherapy; moreover, few clinical audits have been conducted in the field of radiotherapy. The present article describes the aims and current status of the international IROCA "Improving Radiation Oncology Through Clinical Audits" project. The project has several important aims, including the selection of key quality indicators, the design and implementation of an international audit, and the harmonization of key aspects of radiotherapy processes among participating institutions. The primary aim is to improve the processes that directly impact clinical outcomes for patients. The experience gained from this initiative may serve as the basis for an internationally accepted clinical audit model for radiotherapy.

Introduction. The rapid development of new radiotherapy technologies, such as intensity modulated radiotherapy (IMRT) or tomotherapy, has resulted in the capacity to deliver a more homogenous dose in the target. However, the higher doses associated with these techniques are a reason for concern because they may increase the dose outside the target. In the present study, we compared 3DCRT, IMRT and tomotherapy to assess the doses to organs at risk (OARs) resulting from photon beam irradiation and scattered neutrons. Material and methods. The doses to OARs outside the target were measured in an anthropomorphic Alderson phantom using thermoluminescence detectors (TLD 100) 6Li (7.5%) and 7Li (92.5%). The neutron fluence rate [cm−2·s−1] at chosen points inside the phantom was measured with gold foils (0.5 cm diameter, mean surface density of 0.108 g/cm3). Results. The doses [Gy] delivered to the OARs for 3DCRT, IMRT and tomotherapy respectively, were as follows: thyroid gland (0.62 ± 0.001 vs. 2.88 ± 0.004 vs. 0.58 ± 0.003); lung (0.99 ± 0.003 vs. 4.78 ± 0.006 vs. 0.67 ± 0.003); bladder (80.61 ± 0.054 vs. 53.75 ± 0.070 vs. 34.71 ± 0.059); and testes (4.38 ± 0.017 vs. 6.48 ± 0.013 vs. 4.39 ± 0.020). The neutron dose from 20 MV X-ray beam accounted for 0.5% of the therapeutic dose prescribed in the PTV. The further from the field edge the higher the contribution of this secondary radiation dose (from 8% to ~45%). Conclusion. For tomotherapy, all OARs outside the therapeutic field are well-spared. In contrast, IMRT achieved better sparing than 3DCRT only in the bladder. The photoneutron dose from the use of high-energy X-ray beam constituted a notable portion (0.5%) of the therapeutic dose prescribed to the PTV.

Background. We performed a clinical audit of preoperative rectal cancer treatment at two European radiotherapy centres (Poland and Spain). The aim was to independently verify adherence to a selection of indicators of treatment quality and to identify any notable inter-institutional differences. Methods. A total of 162 patients, in Catalan Institute of Oncology (ICO) 68 and in Greater Poland Cancer Centre (GPCC) 94, diagnosed with locally advanced rectal cancer and treated with preoperative radiotherapy or radiochemotherapy were included in retrospective study. A total of 7 quality control measures were evaluated: waiting time, multidisciplinary treatment approach, portal verification, in vivo dosimetry, informed consent, guidelines for diagnostics and therapy, and patient monitoring during treatment. Results. Several differences were observed. Waiting time from pathomorphological diagnosis to initial consultation was 31 (ICO) vs. 8 (GPCC) days. Waiting time from the first visit to the beginning of the treatment was twice as long at the ICO. At the ICO, 82% of patient experienced treatment interruptions. The protocol for portal verification was the same at both institutions. In vivo dosimetry is not used for this treatment localization at the ICO. The ICO utilizes locally-developed guidelines for diagnostics and therapy, while the GPCC is currently developing its own guidelines. Conclusions. An independent external clinical audit is an excellent approach to identifying and resolving deficiencies in quality control procedures. We identified several procedures amenable to improvement. Both institutions have since implemented changes to improve quality standards. We believe that all radiotherapy centres should perform a comprehensive clinical audit to identify and rectify deficiencies.

Background Analysis of the survival rate of cells after irradiation with a specified dose of X-radiation might be one of the basic foundations for assessment of biological implications of ionizing radiation. Investigation of the influence of X-radiation dose rate on cells was carried out in vitro using the SF2 test. Aim The aim of this study was to investigate the influence of X-radiation dose rate on the surviving fraction of the K-562 cell line for two photon energies of 6 MV and 20 MV. Materials/Methods To measure the cells' reaction to X-radiation of variable dose rate human leukaemic K-562 cells were used. In order to fulfil the main aim of the study, the cell line was subjected to irradiation at two different dose rates. Total dose applied at once was 2 Gy. A quantitative evaluation of cell survival rate was carried out at every step of the experiment using a clonogenic assay. Results High dose rate at the energy of 6 MV decreased the percentage of surviving cells to 23%, while lower dose rate decreased it only to 36%. A similar effect is observed at the energy of 20MV-namely at the higher dose rate the percentage of surviving cells is 18%, whereas at the lower one it is only 34%. Conclusions The experiment has shown that when using a lower dose rate, the biological effect of ionizing radiation is less pronounced. However, at a higher dose rate higher radiosensitivity of cells is observed.

Introduction: Treatment of proliferative diseases of the hematopoietic system involves, in most cases, chemotherapy combined with radiation therapy, which is intended to provide adequate immunosuppressant. Conventionally, total body irradiation (TBI) was used; however, total marrow irradiation (TMI) performed with helical tomotherapy (HT) has been proposed as an alternative, with the aim of delivering the highest dose in the target area (skeleton bone). Purpose: The purpose of this study is to evaluate the accuracy of the dose calculation algorithm for the lung in TMI delivered with HT. Methods: Thermoluminescent detectors (TLD-100 Harshaw) were used to measure delivered doses. Doses were calculated for 95 selected points in the central lung (53 TLDs) and near the rib bones (42 TLDs) in the anthropomorphic phantom. A total of 12 Gy were delivered (6 fractions of 2 Gy/fraction). Results: HT-TMI technique reduces the dose delivered to the lungs in a phantom model to levels that are much lower than those reported for TBI delivered by a conventional linear accelerator. The mean calculated lung dose was 5.6 Gy versus a mean measured dose of 5.7 ± 2.4 Gy. The maximum and minimum measured doses were, respectively, 11.3 Gy (chest wall) and 2.8 Gy (central lung). At most of the 95 points, the measured dose was lower than the calculated dose, with the largest differences observed in the region located between the target volume and the adjacent lung tissue. The mean measured dose was lower than the calculated dose in both primary locations: −3.7% in the 42 rib-adjacent detectors and −3.0% in the 53 central lung TLDs. Conclusion: Our study has shown that the measured doses may be lower than those calculated by the HT-TMI calculation algorithm. Although these differences between calculated and measured doses are not clinically relevant, this finding merits further investigation.

Background Mammography is a radiological diagnostic method which relies on an X-ray examination of breasts and is a process involving the use of low-dose amplitude-X-rays (usually around 0.7 mSv). Combining the use of small doses and high quality images requires extensive quality protocols, part of them being included in regulations adopted by the Minister of Health. Aim The aim of this study was to check the usefulness and efficacy of selected quality tests associated with mammography. Material/methods The study was performed in the mammography service of the Greater Poland Cancer Centre in Poznan. Following equipment was used: densitometer, sensitometer, mammographic scales, electronic scales, thermometer, hygrometer, PMMA plates, Europhantom, screen film contact phantom, viewing boxes and magnifying glasses. The methods were based on basic mammography tests. Quality control in mammography demands: clean darkroom, marked and clean cassettes, clean viewing boxes with homogenous light. Results The results of the “Development Process” test show that each sensitometer has to be used with an appropriate densitometer. Phantoms with abnormal structures cannot be used to “AEC System – Solidity exposure” test. “Compression – The force of compression” test may only be carried out with suitable scales and compressible material. Analysis of rejected films shows that the main reasons for rejection were wrong collimation and underexposure. Conclusion Every quality control in mammography provides essential information about the functioning of a laboratory. Apart from recommended standard sterility, it should be remembered that equipment should always be adjusted and repaired.