Upright positioning is re-emerging as a potential strategy to improve the pediatric radiotherapy experience, particularly for selected children in whom distress, limited cooperation, or repeated general anesthesia represent major barriers to treatment. This practice development report, produced by the Upright Radiotherapy Pediatric Task Group — an international, multiprofessional group bringing together radiation oncology, medical physics, radiation therapy, pediatric anesthesia and industry expertise — reviews the historical rationale, contemporary technological developments, and clinical requirements for evaluating upright pediatric radiotherapy. The considerations discussed apply to both photon and proton delivery, although the current economic and dosimetric drivers are strongest for gantry-less proton systems. The concept is supported by historical experience with seated treatment techniques, recent advances in upright imaging and gantry-less delivery systems, and broader pediatric evidence suggesting that seated positioning may improve procedural tolerability. However, pediatric-specific evidence remains limited, and upright treatment should not be regarded as a universal alternative to conventional supine workflows.Safe translation requires a deliberately cautious framework. Key considerations include age-appropriate immobilization, upright imaging and treatment-planning validation, both day-to-day reproducibility and within-fraction stability of setup, gravity-related anatomical changes, audiovisual distraction, and integration of child-centered preparation strategies. For sedated or anesthetized children, upright positioning introduces specific safety requirements related to airway visibility and access, hemodynamic monitoring, patient support, emergency release, rapid transition to a rescue position, and sufficient free space around the patient for the anesthesia team to intervene. These constraints should be treated as primary design and commissioning requirements rather than secondary workflow adaptations.Near-term research priorities include phantom and anatomical validation studies, assessment of imaging and dosimetric accuracy, emergency workflow testing, and prospective pilot studies evaluating setup reproducibility and within-fraction stability, treatment duration, anesthesia utilization, acute safety, and patient- and caregiver-reported experience. If developed within a rigorous multidisciplinary safety and evidence framework, upright pediatric radiotherapy may become a clinically valuable option for selected children, complementing rather than replacing established supine treatment approaches.
Introduction Evidence regarding radiation therapist (RTT)-led follow-up utilising electronic patient-reported outcomes (ePROs) in radiotherapy is scarce. This study evaluated patient and clinician compliance within a novel ePRO-integrated care pathway for prostate cancer (PCa) patients, exploring its impact on communication, involvement, and post-radiotherapy preferences regarding follow-up. Materials and methods Weekly ePROs were collected via a hospital application during treatment and up to 24 weeks post-radiotherapy. During radiotherapy, RTTs monitored acute toxicity in real-time during weekly ePRO-guided symptom reviews. Compliance was defined as ePROs completed and actively reviewed by the RTT. Patient satisfaction was evaluated using a validated Patient Feedback Form. Four weeks after radiotherapy, patients could choose a structured, RTT-led follow-up consultation. Results Of 287 enrolled patients November 2020 – March 2024, 248 (86%) completed The Patient Feedback Form. During active radiotherapy, the pooled patient ePRO response rate was 84.8% (1548/1826), and the RTT handling rate was 88.4% (1368/1548 questionnaires). Patient post-treatment response rates remained high at weeks 12 (88.7%) and 24 (82.5%). ePRO integration improved communication with RTTs (93.0%), symptom discussion (95.5%), and control over care (93.0%). Among 177 having the choice of follow-up, 73% selected RTT-led follow-up. In logistic regression models, no sociodemographic or clinical factors predicted follow-up preference, though older age showed a trend for RTT-led follow-up selection (aOR 1.05, 95% CI: 0.99–1.11, p = 0.086). Conclusions The ePRO-integrated workflow fostered an empowering clinical environment with strong patient involvement. Our findings demonstrated high patient and RTT compliance across the digital pathway in a diverse prostate cancer cohort that significantly improved patient-clinician communication with a feasible, preference-driven post-treatment follow-up.
Background Magnetic resonance imaging (MRI) based IGABT in cervical cancers relies on differential target volume delineation on T2-weighted imaging. Despite decades of experience, there are certain inconsistencies in delineation, with the gross tumor volume (GTV) demonstrating the least concordance. Analyzing current imaging methodologies, in the context of functional imaging, can possibly conceptualize GTV delineation. Methods MRI pelvis datasets of 20 cervical cancer patients at pre-external beam radiotherapy (EBRT) and pre-brachytherapy were selected. The GTV was delineated on the T2 sequence alone and on the fused T2/DWI/ADC sequences. Quantitative and spatial differences between the two delineation methods were analyzed. Results At pre-EBRT, the median absolute difference between GTV_T2 and GTV_T2/DWI was 2 cm3 (−1.72; 8.27, p = 0.117), with strong positive correlation (ρ = 0.943) and moderate to good spatial agreement (Volume ratio: 0.90, DICE Similarity Coefficient (DSC): 0.75, Jaccard Index (JI): 0.61). All lateral tumor extent measurements on one side were higher on T2 imaging, with a maximum of 2.63 cm (1.83;2.87) versus 2.05 cm (1.78;2.39) (p < 0.0001). At pre-brachytherapy, the median difference was 0.30 cm3 (−0.07; 0.77, p = 0.017), with moderately strong correlation (ρ = 0.707) and low to moderate spatial agreement (Volume ratio: 0.79, DSC: 0.33, JI: 0.19). The lateral tumor extent measurement at one of the levels was significantly higher on T2 imaging, being 0.95 cm (0.60;1.78) versus 0.81 cm (0.00;1.39) (p = 0.033). Conclusion The two volumes showed strong correlation; however, small yet statistically significant differences were observed at the pre-brachytherapy, with lesser spatial agreement. T2-only imaging demonstrated higher lateral tumor extent at both time points. Overall, these findings indicate discernible differences with functional imaging.
Purpose:Proton beam therapy (PBT) is a promising modality in kidney stereotactic ablative radiotherapy (SABR). However, the sensitivity of PBT to materials in the beam path enforces special considerations in patient positioning. In clinical practice, we observed significant variability in the skin surface, which may perturb delivered dose. Here, we characterize the impact of skin surface variations in kidney stereotactic body proton therapy (SBPT). Materials and methods:Patients treated with kidney SBPT between 2024 and 2025 were included. Assessment plans were created using 3.0 mm positioning uncertainty in robust optimization to deliver a prescription dose of 50 Gy(RBE) in 5 fractions to 99% of the target volume (iCTV). Virtual CTs were generated for dose accumulation by mapping HU from the planning scan onto the day-of-treatment CBCT. The assessment plan was mapped to each virtual CT set. The dose to 95-100% of the target (iCTV D95-Dmin) and the volume of healthy kidney receiving 10-50 Gy (V10-V50) were compared between planned and accumulated distributions. Results:Fifteen patients treated in 75 fractions were included. The depth of the tumor centroid along the beam path varied by up to 17.4 mm relative to the planned anatomy. Depth variations exceeded 5.0 mm in 22.7% of fractions, and resulted in lower iCTV D95, D98, D99, and Dmin (p < 0.01) compared to assessment plan distributions. The accumulated D99 dropped by up to 24.3%. Conclusion:Skin surface variations may compromise kidney SBPT treatment quality. Further investigation into mitigation strategies, such as adaptive radiotherapy, are merited.
Introduction:Traffic light protocols (TLP) standardize IGRT by reporting anatomical alterations presumed to proxy dosimetric change, yet this assumption is rarely verified. We therefore characterize the daily delivered dose and its longitudinal evolution during adaptive radiotherapy for LA-NSCLC and quantify how TLP reporting relates to dosimetric alteration. Materials and methods:Twenty-two patients with LA-NSCLC enrolled in a prospective trial (604 fractions, mid-treatment adaptation) underwent multi-task automated daily CBCT-based dose monitoring. For each fraction, the delivered dose and the accumulated dose were compared with the reference plan utilizing the existing dose-volume constraints. Longitudinal dose evolution and TLP-code associations were analyzed with piecewise linear mixed-effects models, with significance based on BH-FDR-adjusted q-values (q < 0.10). Results:Daily delivered dose respected planning constraints (median differences within ±3%) but varied between patients. At the population level, only lung V20Gy showed a deviation rate from start (β = 0.082%-points/day; q = 0.044). The deviation rate after plan-adaptation was not significant. Population deviation rates were largely dominated by inter-patient variability. Three DVH-parameters were significantly associated with TLP-codes. Code orange for tumour alterations was associated with PTVp V95% reduction as well as spinal canal D0.03cc increase of respectively -1.73%-points (q = 0.011) and 2.15%-points (q = 0.011). Code orange for spinal-canal alterations was also associated with PTVp V95%-reduction (β = -2.03%-points, q = 0.002). Code orange for lungs showed no significant association with any dose constraint after adjustment for days on treatment. Conclusion:TLP-code orange reporting is a partial proxy for PTV-coverage loss but an unreliable proxy for organ-at-risk dose. Dose deviation rates during treatment are patient specific. This highlights the need for continuous daily dose monitoring to inform ART-decisions during treatment.
Background Clinical trial participation in oncology remains low, despite its importance for advancing treatment. Patients are often asked to consider trial participation in emotionally and cognitively demanding situations, which may limit their ability to engage with complex information and relate decisions to their values and life context. Patient decision aids (PtDAs) may support informed, value-based decision-making, but their feasibility in clinical trial settings warrants further exploration. Objective To qualitatively assess the feasibility of integrating a clinical trial PtDA into routine trial communication and to explore its acceptability and usability in practice. Methods A qualitative feasibility study using interpretive description methodology was conducted. Semi-structured telephone interviews were performed with 11 patients and 14 healthcare professionals involved in a Danish randomised controlled trial comparing photon and proton radiotherapy. Data were analysed inductively. Results Integration of the PtDA into clinical workflows was feasible. However, its acceptability and usability varied depending on how it was introduced and embedded in clinical interactions. Patients engaged with the PtDA in different ways; some used it independently or with family members, while others required clinician support. Participants described the PtDA as supporting understanding and dialogue and as being versatile in different settings, although some needed additional interaction with a clinician to use it meaningfully. Conclusion A clinical trial PtDA can be integrated into routine practice, but its usefulness depends on active implementation and clinician engagement. PtDAs should be implemented as part of broader interventions to support person-centred decision-making and care in clinical trial contexts.
Introduction Cancer-related fatigue (CRF) is one of the most common and distressing symptoms among patients undergoing radiotherapy (RT), impacting quality of life and treatment adherence. While assessment of patient-reported outcomes (PROs) offers a patient-centered approach to symptom monitoring, uptake remains variable. This study examined predictors of fatigue PRO completion, patterns of fatigue across clinician- and patient-reported data sources, and the relationship between baseline physical activity and fatigue severity among patients with breast cancer receiving RT. Materials and methods This retrospective cohort study included patients with breast cancer treated with RT from 2019 to 2023 at a multi-site academic cancer center. PROs were collected using the PRO-CTCAE fatigue item at 2- and 4-weeks post-RT. Logistic and ordinal logistic regressions were used to identify predictors of completion of PRO assessments, clinician-reported fatigue, and fatigue severity. Baseline physical activity collected at diagnosis from 2021 to 2023 was categorized according to American College of Sports Medicine guidelines. Results Among 756 eligible patients, 463 (61%) completed at least one PRO assessment. Non-Hispanic White patients and English speakers were more likely to complete PROs (p < 0.05). Patients with clinician-reported fatigue were less likely to complete PROs (OR 0.61, 95% CI 0.43–0.87). Clinician-reported fatigue was associated with larger RT treatment volumes, while patient-reported fatigue correlated with more RT fractions and race/ethnicity. Meeting exercise guideline recommendations was associated with a trend toward lower clinician-reported fatigue (p = 0.054), but not patient-reported fatigue. Conclusion Fatigue during and after breast RT remains prevalent yet inconsistently captured across data sources. Comprehensive symptom monitoring approaches may enhance early detection and management of fatigue in diverse patient populations.
Background Patients' expectations correlate with outcomes. Yet little is known about multidimensional expectations and associated factors among patients with cancer awaiting radiotherapy. Methods We conducted a cross-sectional survey to explore expectations and associated factors based on the Likert-type Treatment Expectation Questionnaire (TEX-Q) among patients with cancer awaiting radiotherapy. The TEX-Q mean (higher score = more positive overall expectations) was the primary outcome. Secondary outcomes included the TEX-Q Treatment benefit (higher score = more beneficial expectations) and Adverse events (higher score = worse adverse events expectations) subscales. TEX-Q scores range from 0 to 10. We performed univariate and multivariate analyses (MVA). Results Among 368 eligible patients, 140 participated and 133 were analysable. The median age was 67.5 years (interquartile range: 18.8) and the female-male ratio was 1:1. The TEX-Q mean value was 7.0 (SD:1.8), the Treatment benefit mean was 8.6 (SD:1.7), and the Adverse events mean was 4.3 (SD:2.3). Treatment benefit and Adverse events expectations did not correlate. On MVA, overall expectations were worse among patients living alone (p = 0.01), with higher education (p < 0.001), and receiving concomitant chemotherapy (p = 0.048). Treatment benefit expectations were worse among patients with higher education (p = 0.03) and with palliative/unknown intent (p = 0.003). Adverse event expectations were more pronounced among patients living alone (p = 0.01), inpatients (p = 0.04) and more distressed patients (p = 0.01). Conclusions Patients' expectations were favourable overall. Patients living alone, treated with palliative intent and at more distress expected worse outcomes which may require adapted communication strategies or supportive measures. Future longitudinal studies should investigate expectation-outcome pairings and interventions to realistically improve patients' expectations regarding radiotherapy.
The Mission of Brave - Let's turn radiotherapy into an adventure! is a person-focused preparation and education programme developed to reduce anxiety and improve engagement among paediatric patients (aged 0-18) across seven Hungarian radiotherapy centres. From May 2023 to May 2026, 256 children participated in this nationwide initiative. The programme integrates storytelling, play-based education, and environmental transformation. Core elements include a themed gift box with a LEGO linear accelerator model, storybooks, interactive activities, personalised immobilisation mask decoration, comfort objects, and symbolic milestones. By framing radiotherapy as a heroic mission with the character 'Brave', the programme enhances understanding, reduces fear, and promotes cooperation through multidisciplinary staff collaboration. Notably, in 5 cases, improved procedural familiarity directly eliminated the need for general anaesthesia. Integrated into routine clinical preparation and supported by charitable donations, this programme provides a practical model for improving patient experience in paediatric radiation oncology.
Daily cone-beam computed tomography (CBCT) based image-guided radiotherapy (IGRT) with six degrees of freedom (6DOF) is standard for head and neck cancer. We retrospectively analyzed 669 sessions from 20 patients, using CBCT guided 6DOF couch corrections followed by ExacTrac Dynamic adjustments. Surface-guided radiotherapy (SGRT) continuously monitored intrafraction motion, triggering verification images and couch shifts when tolerances were exceeded. Pitch and roll deviations were linked to translational misalignments up to 3 mm. SGRT prompted repositioning in 100 sessions (15%), although nearly half of these movements were false positives. This demonstrates SGRT's value as a complementary, non-invasive tool for intrafraction monitoring.
Purpose: Radiotherapy can be a frightening experience for paediatric patients due to unfamiliar equipment, immobilisation, separation from parents during treatment, and limited understanding of the procedure. The Mission of Brave - Let's turn radiotherapy into an adventure!, a person‑focused preparation and education programme was developed to reduce anxiety and improve engagement among children undergoing radiotherapy.Methods: The programme was developed at the National Institute of Oncology in Hungary and integrates storytelling, play‑based education, and environmental transformation to support children aged 3–14 years before and during radiotherapy. Core elements include a themed preparation gift box containing a LEGO linear accelerator model, educational storybooks, interactive activities explaining radiotherapy procedures, personalised immobilisation mask decoration, comfort objects, and symbolic milestones throughout treatment.Results: Since its introduction in 2023, more than 250 paediatric oncology patients in Hungary have participated in the programme. By framing radiotherapy as a heroic mission involving the character ‘Brave’, the initiative aims to improve children's understanding of treatment, reduce fear associated with radiotherapy procedures, and promote cooperation during treatment sessions. For example, the need for daily general anaesthesia can potentially be reduced or omitted. The programme has been integrated into routine clinical preparation for paediatric radiotherapy patients and is supported through charitable donations.Conclusion: The Mission of Brave demonstrates how creative, person‑focused interventions can transform the paediatric radiotherapy experience. By combining education, narrative engagement, and environmental design, the programme provides a practical model for improving patient experience in paediatric radiation oncology.
Purpose:Troubleshooting linear accelerator faults during patient care is time-critical and cognitively demanding. Access to relevant historical information is often slow and experience-dependent. To streamline information retrieval and support decision-making, a TrueBeam troubleshooting chatbot powered by a large language model (LLM) was developed and tested. Methods:Troubleshooting records from five TrueBeam linacs over eight years were extracted from an in-house database. After removing non-UTF-8 characters and normalizing formatting, each issue was stored as a structured text file for retrieval. Files were indexed in a GPT-4.1-based environment, with parameters (e.g., temperature, retrieved chunks) iteratively tuned. Performance was evaluated using standardized questions across domains including recall, real-time troubleshooting, aggregation, safety, and temporal filtering. Four physicists scored responses using a predefined rubric. Results:A total of 1394 logs (5.4 MB) were indexed, with indexing completed in 16 min. Mean response time was 7.5 ± 2.5 s. The chatbot performed well in retrieving prior events, summarizing institutional experience, and recognizing when information was unavailable. Performance was largely insensitive to temperature and chunk number, except under severely limited retrieval. Weaknesses included occasional procedural misordering, unclear responsibility between physicists and service personnel, verbosity, and inconsistent temporal filtering. Conclusion:A GPT-4.1-based RAG chatbot can rapidly surface relevant institutional knowledge for linac troubleshooting and may reduce cognitive burden during machine faults. However, important safety and workflow risks remain. Such systems should function as decision-support tools and require explicit guardrails, role definition, and formal risk evaluation prior to broad clinical deployment.
Background and purpose Respiratory motion is a major challenge in paediatric thoracic radiotherapy, where minimizing exposure to healthy tissues is essential to reduce long-term toxicity. Mechanically-assisted non-invasive ventilation deep inspiration breath-hold (MANIV-DIBH) allows non-sedated patients to achieve repeated, reproducible breath-holds, potentially reducing safety margins and improving dose conformity. We report the first paediatric application of this technique during whole lung irradiation (WLI). Material and methods A 10-year-old girl with metastatic Ewing sarcoma was referred for WLI. A preparatory session with a physiotherapist was performed to introduce MANIV-DIBH with child-adapted communication and select the optimal non-vented oronasal mask. Ventilator settings for assisted breath-holds were tailored to the patient's tolerance. The goal was to achieve multiple 20-s breath-holds. The simulation CT was acquired during MANIV-DIBH. WLI (15 Gy in 10 fractions) was planned with IMRT. Results The patient performed stable and reproducible 20-s breath-holds across 10 sessions, with an average fraction time of 32.1 (±7.8) minutes. Treatment was well tolerated, with grade 2 fatigue. Follow-up PET/CT showed complete response and no imaging signs of toxicity. Conclusion This first paediatric clinical application of MANIV-DIBH suggests feasibility, stability, and good tolerability. Its successful use required careful, multidisciplinary implementation and adaptation to the paediatric setting. These preliminary findings support further evaluation in this population.
Purpose To determine if version upgrades to treatment planning system software have an impact on the clinical application of a knowledge-based planning model built in a previous version. Methods Twenty patients’ data sets treated for prostate cancer were retrospectively selected for planning on three different versions of Eclipse (Varian Medical Systems) treatment planning system, (Vn13.6, Vn15.6, Vn16.1) using a multi-centre RapidPlan model that was built in Vn13.6. Each plan was created using identical beam arrangement, and optimisation objectives and calculation settings. The RapidPlan model was also re-trained in Vn15.6 and Vn16.1 and the datasets were replanned using these models with the same method. Results Seven plan comparisons were performed, evaluating four target metrics and eight organ at risk (OAR) metrics. Statistically significant differences to median values for target dose metrics were observed in 10 out of 28 plan comparisons and for OARs in 23 out of 56 plan comparisons. Re‑extracted and re‑trained models in Vn15.6 and Vn16.1 improved target coverage and several OAR dose metrics. Small increases were observed in some OAR metrics for a subset of plans using the Vn15.6 model; however, the largest variations were minor (≤1.4%), including Bladder_65Gy (<1.3%), Bladder_70Gy (<0.7%), Rectum_65Gy (<0.9%), and Rectum_70Gy (<1.4%). Conclusion Eclipse version upgrades will have varying effects on the resultant plans optimised using a RapidPlan models developed and trained in earlier versions. This study confirms the recommendation from the vendor that it is important to re-extract and re-train RapidPlan models when an Eclipse version upgrade is undertaken to ensure optimal dosimetry is achieved.
Background and purpose:Patient or treatment plan mix-ups are among the most serious patient-specific human errors in brachytherapy. However, many brachytherapy departments rely only on review by a second, independent person, which does not eliminate the risk of human failure. In this work, we developed and retrospectively evaluated an automated patient identification method based solely on the geometry of the interstitial implant in breast cancer patients. Materials and methods:The implant geometry is assessed using an electromagnetic tracking (EMT) system that provides real-time positional data of each catheter with sub-millimetre accuracy. The measured implant geometry is rigidly registered to the CT-based implant geometry associated with the clinical treatment plan. To quantitatively compare them, a similarity metric based on a distance-to-agreement (DTA) criterion (3-10 mm) and a pass rate threshold (50-95%) was used. The implants of 80 patients were included in the evaluation, resulting in 6400 patient-treatment plan combinations. Results:The classifier reliably identified patients with an area under the receiver operating characteristic (ROC) curve close to 1, highlighting an overall excellent discriminative performance. At the optimal decision threshold under the requirement of a false positive rate of 0%, it achieved a sensitivity between 94.8% and 97.5% depending on the DTA and pass rate thresholds, and an overall accuracy of 99.9%. Conclusion:Interstitial implants in breast brachytherapy are virtually unique, so determining their geometry prior to each fraction is a viable option for patient identification. The EMT-based automated technique has proven to be effective in detecting patient or treatment plan mix-ups with near-perfect accuracy.
A positioning device, the “Ting-Sling”, was created to move the external genitalia away from the treatment field and improve the experience of patients with sarcoma cancer. A five-point Likert scale questionnaire was used to evaluate the patient and RTT experience, positioning and modesty. Descriptive feedback was also collected. Ninety-eight percent of the patients and 87% of the RTTs, rated the Ting-Sling, as good or excellent. Patient satisfaction was high in dressing the external genitalia and preserving their modesty when receiving radiotherapy to the proximal lower limb (thigh).
Online adaptive radiotherapy (oART) represents a significant advancement in personalised radiation cancer treatment, offering improved daily dose to targets and optimised organ exposures with reduced toxicity. Implementation remains challenging due to resource intensiveness, workflow complexity and workforce limitations. This article presents international insights on optimising oART delivery with a focus on practice development and workforce transformation. Strategies are explored to improve workflow efficiency, integration of artificial intelligence (AI) and the role of both therapeutic radiographers and radiation therapists (RTTs) in leading adaptive workflows. Credentialing frameworks for RTTs are examined as a mechanism to support sustainable oART delivery and reduce clinician console time. The discussion synthesises practical innovations from across multiple international healthcare systems, highlighting reproducible models for efficiency, workforce training and AI integration. These insights aim to guide global efforts in scaling oART delivery through efficient and collaborative practice models that align with safe, accessible patient-centred care.
Background and Purpose: Despite widespread recognition of the value of research among radiation therapists (RTTs), sustained engagement remains low across international settings. This study aimed to explore RTT perspectives on research engagement, characterise the cultural conditions shaping participation, and generate structured recommendations for strengthening RTT research culture. Materials and Methods: A qualitative, workshop-based study was conducted through the ESTRO RTT workshop series. A sixteen-member Research Engagement Expert Reference Group (RE-ERG), drawn from ten countries, participated in two virtual sessions. The cultural web framework was applied in Workshop 1 to map research culture across six organisational elements. In Workshop 2, participants validated findings and developed recommendations structured around three strategic pillars: Preserve, Adapt, and Innovate (PAI). Real-time polling and recorded transcripts were analysed using deductive thematic analysis informed by the cultural web framework. Results: Two cross-cutting tensions emerged: a persistent recognition-to-practice gap in which strong endorsement of research coexisted with structural barriers to participation, and a reliance on individual commitment rather than systemic support, with research frequently described as "hidden work" conducted outside rostered hours. 15/16 participants (94%) agreed that RTTs could make a significant contribution to research. The Preserve pillar identified five foundational strengths including collaboration, mentorship, visibility, organisational support, and patient-focused research. The Adapt pillar generated recommendations addressing education, governance simplification, career pathway clarity, and protected time. The Innovate pillar emphasised research champion roles, graduated fellowship schemes, digital collaboration platforms, and embedding research within departmental objectives and international networks. Conclusion: RTTs collectively articulate a clear and actionable vision for research culture development, yet realising it requires coordinated action from departments, national professional bodies, and international organisations. Applying the cultural web framework alongside the PAI pillars produced practitioner-grounded recommendations that move beyond barrier identification towards infrastructures that make research participation an expected and enabled dimension of RTT professional practice.
Reduced recruitment and retention of radiation therapists (RTT) significantly impacts patient care and the profession. The European Society for Radiotherapy and Oncology RTT workshop explored professional motivation, early career experiences, progression and continuous education, and job satisfaction. Participants were initially motivated by working in a specialised, technology-driven field and making a meaningful patient impact, later shifting toward team-oriented goals. Addressing these evolving motivations is key to improving retention. Suggested strategies include fostering belonging during student placements, enhancing graduate onboarding, ensuring equal access to research and education funding, and enabling leadership autonomy to provide protected time from clinical duties.
Delivering radiotherapy in upright body positions (UP) may offer advantages for breast and lung cancer treatments due to physiological/anatomical differences compared to the supine position (SP), as well as potential cost savings when establishing new treatment rooms. This pilot study compared (i) patient experiences and (ii) lung function parameters for upright UP versus SP, among a cohort of patients undergoing conventional (supine) radiotherapy for breast or lung cancer.After ethical approval, 8 breast and 7 lung cancer patients were enrolled in this study. Five research appointments were conducted for each patient. Patients were set-up with UP and SP with their arms raised out of the thoracic region. Through questionnaires, patients reported on any discomfort, their general experiences and their preferred setup. Spirometry-based measurements taken included the tidal Volume (Vt), vital capacity (VC), and maximum duration of Deep Inspiration Breath Holding (DIBH). Expiratory Reserve Volume (ERV), Inspiratory Capacity (IC) were calculated.Discomfort was most frequently reported in the lower back during SP and in the knees during UP. Nine patients preferred UP for physical comfort and 8 preferred UP for DIBH whereas 1 and 6 preferred SP respectively. Patients described significantly less pain when they stood up after the UP than after SP. In UP, ERV was significantly larger (p < 0.05), while Vt and IC were significantly smaller (p > 0.05) compared to UP. There was no difference in VC between the two positions (p = 0.17).The majority of patients preferred UP and reported being more comfortable in UP in comparison to SP. Overall, body position influences Vt, ERV and IC but no differences were observed in VC, consistent with the literature. DIBH was feasible for all patients in both positions.
