Heidi Probst

Retaining therapy radiographers: What’s so special about us?

High therapist vacancy rates and an unsatisfied workforce reduce the opportunity to meet waiting time targets or maintain high standards of care. Current vacancy rates may conceal true staff shortages because of financial pressures. Levels of job satisfaction among the therapy radiographer workforce are presently unknown. A multi-phase study to investigate job satisfaction of therapy radiographers in the United Kingdom is under way. Phase I was an interpretive grounded theory study and, as interviews progressed, a review of the literature on job satisfaction was warranted (in line with the principles of grounded theory). The purpose of this article is to evaluate the literature on job satisfaction as a way to inform the development of retention strategies within the radiotherapy profession. The discussion is focused under the following three themes identified from our phase I study: job design, leadership and organisational governance, stress and burnout. A number of models within the wider literature can inform retention strategies for radiotherapy managers. In particular, the job characteristics model and the model for job-specific well-being adequately identify factors that are relevant to the work of a therapy radiographer. Ensuring mental challenge through job design and continuing professional development opportunities is vital to retaining staff. Support from immediate managers is also a crucial aspect of workers development of intentions to leave. Manager support can moderate experiences of job stress, limiting job dissatisfaction and reducing leaving intentions. Stress and burnout have been cited as significant in reducing job satisfaction in health workers. In the United States, high levels of emotional exhaustion among radiation therapists highlight the potential for the development of burnout within the UK therapy workforce. The discussion looks at the importance of these characteristics within a general retention strategy and recommends future areas of study.

Increasing the work speed of radiographers: the effect on the accuracy of a set-up of a complex shaped cranial field, part of a matched cranio spinal junction

Simulator port films of 22 set-ups of a complex cranial field positioned by radiographers working either at normal or at increased pace were compared with a control film. Analysis showed that accuracy decreased for set-ups achieved at an increased speed, demonstrating risks to treatment outcomes incurred by increasing working speed to meet workload demands.

Split course radiotherapy for bladder cancer in elderly unfit patients.

Between 1980 and 1987, 89 patients with T1-T4 carcinoma of the bladder were treated with a split course of external beam radiotherapy. All patients were felt to be unsuitable for a prolonged course of radical radiotherapy because of age and/or poor general health. The intention was to provide local control. The majority of patients were treated with 10-12 fractions, with a mean dose of 45 Gy (range 31.5-57.7), within a mean overall time of 48 days. Of the 89 patients only 62 were assessable with a median follow-up of 110 months (range 64-157). In the remainder, poor health, poor performance status, or early (< 3 months) death did not allow assessment of tumour control. Complete remission was achieved in 28/89 (31%) patients. This was highly dependent on T stage: 56% T1/T2, 30% T3a/T3b, 5% T4. Median survival for patients with Stage T1/T2, T3a/T3b and T4 disease was 22, 10 and 8 months respectively. Acute grade 1-2 radiation reactions occurred in 60% of these patients, and only 5/62 (8%) experienced grade 2-3 late complications, assessed according to the RTOG scoring system. No patient had more severe treatment related morbidity.

Radiotherapy waiting times, resources and protocols for breast carcinoma: a survey of UK radiotherapy centres

Purpose: Radiation techniques employed for breast cancer must be efficient as well as effective in order to minimise waiting lists. Protocol restrictions, or the technical application of treatment, may influence planning and treatment times as radiographers follow departmental policies. A national survey of UK radiotherapy centres was undertaken to establish trends in waiting times for breast cancer irradiation; and to investigate relationships of waiting times with the deployment of equipment and personnel and technical procedures adopted. Method: A questionnaire was posted to the Head of Radiotherapy Services and a Clinical Oncologist with an interest in breast cancer in the radiotherapy centres in the UK. Survey questions investigated a number of issues, including the number of breast patients planned per week; protocols chosen; average treatment and planning times; levels of personnel and equipment; and the population served. Results: A total of 53 centres were contacted, of which 51 centres responded to some aspect of the survey (96%). Average waiting times for treatment fluctuated from 1 to 7 weeks and maximum waiting times of 11 weeks were reported. Variation in clinical practice was found, including procedure times and the number of radiographers employed per linear accelerator. A multiple regression analysis indicated that a combination of equipment levels, simulation times, and the number of breast contours taken best predicted the average waiting time for breast treatment. Conclusion: Waiting times reported were influenced by a combination of levels of equipment available and protocols adopted.

Breast Volume Calculation Using a Low-Cost Scanning System

Breast volume has been identified as a key metric in assessing patients for reconstructive surgery. Scanning systems have measured breast volume but they have tended to rely on expensive hardware and software. This paper discusses the development and assessment of an algorithm capable of calculating breast volume from 3D point data. A mannequin was scanned (using a custom, Kinect based scanning system) with one of two breast prostheses attached – 400g or 600 g. Each scan was assessed by three independent operators: seven anatomical points were identified representing the boundary of the breast region, which was then isolated. A Coons patch was used to represent the invisible chest surface lying below the breast tissue. A trapezium rule based approach was used to calculate the volume of the enclosed region between the breast and chest surfaces. Breast volume over-estimated by 130 cc with the 400 g prosthesis (30.3%) and 206 cc (33.3%) with the 600 g prosthesis, suggesting positive proportional bias. Average reliability was ± 59.7 cc for the 400 g prosthesis (13.9%) and ± 34.7 cc for the 600 g prosthesis (5.6%) – approaching the levels required to differentiate between implant sizes (25 -50 cc). Future work will focus on refining the hardware and software of this scanning system – minimising proportional basis and maximising reliability of measurement.

2 INSPIRE: Increasing Intrapreneurial Skills through Pedagogy

Abstract The Department of Health QIPP (Quality Innovation, Productivity and Prevention) agenda requires health practitioners to consider efficient and productive ways of providing safe care for patients- this agenda needs innovative, intrapreneurial practitioners across a range of professions to drive change. Intrapreneurship is an individual intention or drive to innovate within an organisation, developing and implementing novel solutions to organisational problems often in a ‘bottom-up’ way. Research shows formal education increases the confidence of professionals moving into specialist roles; intrapreneurship is particularly relevant to these roles but the development of skills for enterprising activity is rarely attended to in NHS training. The aim of this project was to develop and implement an intrapreneurial pedagogy. The study focused on oncology practitioners although the study outcomes have relevance to the wider education of Health Care Practitioners (HCP). An interpretive methodology was adopted to gain insight into the learning experiences of identified intrapreneurs within the specialism of radiotherapy. Individual interviews augmented with evidence on entrepreneurial learning from the literature was used to model a development path to intrapreneurialism that was then used as the basis for an intrapreneurial pedagogy. The intrapreneurial pedagogy was then piloted on a small cohort of masters students studying an oncology module on breast cancer.

Integrating E-Learning into Postgraduate Radiotherapy and Oncology Education: A Case Study

Training health professionals within university environments has traditionally focused on face-to-face methods. Practitioners working within the UK National Health Service (NHS) have found it difficult to gain leave from work to attend for study due to the demands of the NHS and staff shortages. In response, the authors developed a distance e-learning course to match the current traditional taught programme. The first e-learning module (a research methods module) was comparable in content to the traditional taught module, and developed to incorporate a formative assessment design throughout, embodying the constructivist approach and the principle of assessment for learning. The authors evaluated student experiences with the e-learning module using a pre- and post-module questionnaire, with the taught cohort used as a comparison. They tested the importance of support, levels of information technology (IT) skills, preferences for e-learning and intrinsic motivation. The results identified that highly satisfied e-learning students were more likely to report a preference for e-learning initially, show higher levels of intrinsic motivation and report good support from tutors and fellow students. This article discusses the development and evaluation of the pilot module and some of the lessons learned from providing e-learning to health workers.

The development of a low cost 3D surface imaging system to measure breast volume: defining minimum standards using an adapted Delphi consensus study

Breast reconstructive surgery has become an accepted part of the patient pathway for breast cancer patients requiring mastectomy. Yet the UK National Mastectomy and Breast Reconstruction Audit (2011)(1) identified that one in four women were not satisfied with how their unclothed breasts looked after delayed reconstructive surgery. Women with an intact breast after surgery are generally referred for whole breast irradiation, radiotherapy increases the risk of these women developing breast oedema.

Imaging Biomarkers for Precision Medicine in Locally Advanced Breast Cancer

Guidelines from the American National Comprehensive Cancer Network recommend neoadjuvant chemotherapy to patients with locally advanced breast cancer (LABC) to downstage tumours before surgery. However, only a small fraction (15%-17%) of LABC patients achieve pathological complete response (pCR); that is, no residual tumour in the breast, after treatment. Measuring tumour response during neoadjuvant chemotherapy can potentially help physicians adapt treatment, thus potentially improving the pCR rate. Recently, imaging biomarkers that are used to measure the tumours functional and biological features have been studied as pretreatment markers for pCR or as an indicator for intratreatment tumour response. Also, imaging biomarkers have been the focus of intense research to characterise tumour heterogeneity as well as to advance our understanding of the principle mechanisms behind chemoresistance. Advances in investigational radiology are moving rapidly to high-resolution imaging, capturing metabolic data, and performing tissue characterisation and statistical modelling of imaging biomarkers, with an end point of personalised medicine in breast cancer treatment. In this commentary, we present studies within the framework of imaging biomarkers used to measure breast tumour response to chemotherapy. Current studies are showing that significant progress has been made in the accuracy of measuring tumour response either before or during chemotherapy, yet the challenges at the forefront of these works include translational gaps such as needing large-scale clinical trials for validation and standardisation of imaging methods. However, the ongoing research is showing that imaging biomarkers may play an important role in personalised treatments for LABC.

Response to Editorial in the JRP by Robson, Clark and White 2014 patient safety: the journey towards safer radiotherapy

The rate of events within radiation oncology is difficult to estimate, as there are marked interstudy and inter-database differences in the methods used to define an event. Based on the available data, a reasonable estimate is that there is an event during the course of treatment in ,1–3% of patients, but the vast majority of these are not clinically relevant. Importantly however, E1 in 1,000–10,000 treated patients is affected by a reportable event with potentially serious consequences. This compares unfavourably with high reliable industries such as commercial aviation (E1 death in 4?7 million passenger flights; or other areas of medicine such as anesthesiology (E1 death in 200,000 procedures). The relatively high rate of any type of event within radiation oncology is cause for concern as it suggests inherent shortcomings of our current systems. Further, there is reason to suspect that the risk of serious incident that reaches patient within radiation oncology might be increasing. Given the uncertainties in collected quantitative data related to the probability of incident, and their clinical severities, it is challenging to prove or disprove this suspicion. A successful outcome requires multiple persons with diverse responsibilities and capabilities to repeatedly perform in a Correspondence to: Heidi Probst, Radiotherapy and Oncology, Faculty of Health and Wellbeing, Sheffield Hallam University, Robert Winston Building Collegiate Crescent Campus, Sheffield S10 2BP, UK. Tel: 0114 2254359. Email H.Probst@shu.ac.uk