Background: Assessment tasks in health professional education (HPE) risk becoming outdated if they remain static. This study aimed to quantify the rate and magnitude of assessment renewal in Australian health professional teaching programs (HPTPs)—programs that provide educational qualifications to health professional educators, which are likely to reflect best practice in educational processes—and to explore the factors that influenced assessment renewal, thereby establishing foundational benchmarks for the pre-entry HPE sector and a platform for future research into renewal practices. Methods: HPTPs were selected as our sample as they were considered most likely to represent best practice. Relevant Australian qualifications were identified from official university sources. Assessments for each university subject were compared as delivered in 2018 and 2023. Differences were quantified. ANOVA and Fisher’s exact test were used to test for association between rates of change and subject delivery mode/delivery institution. Results: There were 69 university subjects with matched assessment details in 2018 and 2023. Altogether, 403 assessments were reviewed, 205 from 2018 and 198 from 2023. During this time, 50.7% (35/69) of subjects had their assessments modified, with 34.8% (24/69) modified in a major or complete fashion (>20% change). There were significant differences between institutions in the likelihood of assessment renewal (p < 0.001). Despite an increase in the number of subjects delivered online (54.9% to 75.6%), no association was found between transitioning to online delivery and the likelihood of assessment change (p = 0.245). Conclusion: Approximately half of all assessments were revised in Australian HPTPs between 2018 and 2023, and notable differences in renewal practices were evident between institutions. Further in-depth exploration of renewal processes will ultimately help to guide best-practice recommendations.

Accelerated partial breast irradiation (APBI) delivers a higher dose to a smaller breast volume with equivalent tumour control to whole breast irradiation and improved cosmesis. The MR-Linac offers superior soft tissue visualisation and adaptive planning, but limited bore size may result in skin-couch contact, potentially affecting skin dose. This retrospective pilot study evaluated the effect of MR-Linac couch contact on skin dose. Three patients with left-sided breast cancer positioned prone with unavoidable skin-couch contact were included. MR images were acquired using a 1.5 T MR simulator and contoured for target and organs-at-risk. Step-and-shoot IMRT plans (30Gy in 5 fractions) were optimised and recalculated with and without magnetic field presence. Dose to the whole skin rind (Skin_Rind) and couch-contact region (Skin_Rind_Ant) were compared. All plans met target and OAR constraints. Mean Skin_Rind dose was consistently higher with magnetic field presence, while dose to Skin_Rind_Ant was consistently lower. These findings contrast with conventional linac data, suggesting magnetic field and interface effects may alter skin dose deposition.

Purpose:Assisted breath-hold (BH) is a motion management strategy facilitating safe dose-escalated radiation therapy. Treatment efficiency largely depends on patient training and BH capability, which are crucial for the viability of routine BH treatments. Although strategies to extend BH time exist, the efficiency of upper abdominal radiation using the Active Breathing Coordinator remains unreported. The aim of this prospective study was to undertake a novel evaluation of BH efficiency following personalized technique screening. Methods and Materials:Patients presenting for radiation therapy to the upper abdomen, including liver, kidney, pancreas, or adrenal gland, were approached for inclusion. Participants underwent screening to personalize the selection of the BH technique with a prespecified novel decision support algorithm using the Active Breathing Coordinator. BH time, treatment time, and number of BHs were recorded for the first three treatment fractions and used to calculate BH efficiency. Results:Sixteen patients underwent treatment following screening and assessment to personalize their BH technique selection. The overall mean BH time was 22.8 (range, 15-30) seconds, and a mean of 10 (range, 5-18) BHs were required to complete each fraction. Descriptive statistics, including Student t tests and linear mixed-effects models, were used to describe the data. The mean cohort efficiency was 0.47 (SD, 0.12). This improved from 0.45 (SD, 0.12) at fraction 1 to 0.50 (SD, 0.13) at fraction 3, regardless of technique. Efficiency was higher in the inspiration BH subgroup (mean, 0.52; SD, 0.12) compared with expiration BH (mean, 0.45; SD, 0.10; P = .060) and deep-inspiration BH (mean, 0.39; SD, 0.09; P = .005). Patients with BH times of 25, 30, and 38 seconds had statistically significantly higher efficiency than patients with 15 seconds, irrespective of BH technique. Conclusions:Efficiency improved with increasing BH time. Efforts to improve BH time, such as comprehensive training programs, may aid in achieving the maximum benefit of BH techniques.

INTRODUCTION:Renewing a health professional education (HPE) curriculum is a significant undertaking, requiring substantial effort and resourcing. However, the factor(s) that should initiate a curriculum renewal remain contentious, and the methods to best assess them are unclear. To begin answering these questions, a comprehensive view of the scope of potential renewal drivers is needed, thus enabling structured inquiry into these (and their interactions) while ensuring no driver categories are being inadvertently overlooked. It would similarly serve as an important checklist for individual institutions undergoing renewal. However, no such list has ever been formulated in a data-driven way. Thus, this scoping review aimed to document the full range of real-world drivers of HPE curricular renewal and create an overarching categorisation of these. METHODS:A systematic search was conducted of the Embase, Medline/PubMed, Global health and CINAHL databases for studies published between 2013 and 2023 describing a completed single-institution curriculum renewal of an entry-to-practice HPE degree. Following independent screening, articles were reviewed and 'extent of renewal', 'renewal characteristics' and the 'initiating driver(s)' of renewal were extracted. Descriptive statistics were generated, and qualitative content analysis performed to generate a categorisation of renewal-initiating drivers. RESULTS:The search identified 1408 potential manuscripts, and 239 publications describing 247 renewals were analysed. Forty percent were whole-of-degree renewals. Institutions from all continents were represented. Seventy-seven initiating drivers were identified and grouped into 10 categories: 'Regulatory reasons', 'Pedagogical improvements', 'Community/patient needs', 'Learner experience/satisfaction', 'Exceptional events', 'Learner outcomes', 'Industry benchmarking/reputation', 'Practical/business factors', 'Knowledge/skill issues' and 'Periodic renewals'. 'Regulatory reasons' were the most common reason for whole-of-degree renewals and 'knowledge/skill issues' for part-of-degree renewals. CONCLUSIONS:HPE curricula renewals have a wide range of initiating drivers. The proposed categorisation of these should serve as a useful scaffold for institutional curricular review processes and also for directing future scholarly inquiry into curricular renewal.

Effective communication is a critical aspect of cancer care delivery. Specific communication challenges exist for culturally and linguistically diverse (CALD) patients and healthcare professionals throughout cancer treatment. This literature review aimed to examine the cancer treatment experience of CALD patients. A systematic scoping review was conducted in January 2025 using the databases; OVID Medline, EMBASE, and Cochrane Central. Search parameters included cancer, cultural diversity, language, and patient experience. Adhering to PRISMA guidelines and an established PICOS framework, 47 articles were selected for review. Exclusion criteria omitted duplicates, non-English language publications, articles published prior to 2010, and those unrelated to oncology and/or CALD communities. Three overarching themes were established from the literature; (1) education empowerment, (2) quality care provision, and (3) system-level change. Communication barriers impacted the experience of cancer care and compromised treatment outcomes. Translated resources and staff cultural awareness training were observed to be beneficial for CALD patients. There is justified need to improve communication supports and resources for CALD patients and their clinicians. However, radiotherapy (RT) specific research is required to safely implement, contextualise and validate findings – informing bespoke communication improvement opportunities within RT practice.

Background and purpose:Upper abdominal malignancies are relatively rare, and although surgery is considered the primary treatment option, radiation therapy has an emerging role in the management of liver, pancreas, kidney and adrenal gland tumours. Furthermore, stereotactic radiation therapy for the management of upper abdominal metastases is an expanding clinical indication. Breath-hold is one respiratory motion management strategy used in upper abdominal radiation therapy, and the reproducibility, and stability of breath-hold is critical for overall treatment accuracy. Materials and methods:A systematic review of the literature was conducted in Medline, Embase and Cochrane databases with keyword and vocabulary terms related to radiation therapy, breath-hold and upper abdominal tumours. Results:Following screening against the selection criteria, 41 studies were included. Breath-hold reproducibility was the most commonly reported outcome and exhale breath-hold was the most common type. Studies were either prospective or retrospective cohort studies, and the mean sample size was 19 participants. The risk of bias of each included study was assessed, and the mean quality assessment score for included studies was 90 % (77-100 %). Median exhale breath-hold cranio-caudal inter-fraction reproducibility was 0.6 mm, (IQR 0.3-1.6 mm), compared to inspiratory breath-hold 0.0 mm (IQR -0.6-2.97 mm). Stability measurements were ≤3 mm in 71 % of studies, irrespective of breath-hold type. Discussion:Formulating institutional protocols for best clinical practice regarding breath-hold for upper abdominal tumours is challenging, given the significant variation in practices, interventions and definitions observed in the literature. Further investigation to individualise breath-hold strategies and safety margins is warranted.

Background: Accelerated partial breast irradiation (APBI) is an accepted treatment option for early breast cancer. Treatment delivered on the Magnetic Resonance integrated Linear Accelerator (MRL) provides the added assurance of improved soft tissue visibility, important in the delivery of APBI. This technique can be delivered in both the supine and prone positions, however current literature suggests that prone treatment on the MRL is infeasible due to physical limitations with bore size. This study aims to investigate the feasibility of positioning patients on a custom designed prone breast board compared with supine positioning on a personalised vacuum bag. Geometric distortion, the relative position of Organs at Risk (OAR) to the tumour bed and breathing motion (intrafraction motion) will be compared between the supine and prone positions. The study will also investigate the positional impact on dosimetry, patient experience, and position preference. Methods: Up to 30 patients will be recruited over a 12-month period for participation in this Human Research Ethics Committee approved exploratory cohort study. Patients will be scanned on the magnetic resonance imaging (MRI) Simulator in both the supine and prone positions as per current standard of care for APBI simulation. Supine and prone positioning comparisons will all be assessed on de-identified MRI image pairs, acquired using appropriate software. Patient experience will be explored through completion of a short, anonymous electronic survey. Descriptive statistics will be used for reporting of results with categorical, parametric/non-parametric tests applied (data format dependent). Survey results will be interpreted by comparison of percentage frequencies across the Likert scales. Thematic content analysis will be used to interpret qualitative data from the open-ended survey questions. Discussion: The results of this study will be used to assess the feasibility of treating patients with APBI in the prone position on a custom designed board on the MRL. It may also be used to assist with identification of patients who would benefit from this position over supine without the need to perform both scans. Patient experience and technical considerations will be utilised to develop a tool to assist in this process. Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN1262400067583. Registered 28th of May 2024. https://www.anzctr.org.au/ACTRN12624000679583.aspx

Purpose Culturally and linguistically diverse (CALD) cancer patients report unmet informational and emotional needs when receiving radiotherapy (RT). This feasibility study aimed to evaluate the clinical use of an instant translation device (ITD) to facilitate communication between Mandarin-speaking patients and radiation therapists (RTTs) within the Australian public RT setting. The primary aim was to assess the ability to convey information relating to daily patient care and build rapport using the device. Methods A single-arm prospective interventional trial was employed with patient and RTT participants. Eligible patient participants were aged 18 years or older, diagnosed with cancer, referred for RT with self-reported Mandarin as the primary language spoken at home. Patients who had previously received RT were excluded. Consenting patient participants completed a baseline assessment of health literacy (REALM-SF) and English proficiency (LexTALE). Surveys were administered to patients and consenting RTTs at the cessation of treatment, forming two distinct participant groups. Descriptive statistics were used to compare participant groups. Results Eleven patients and 36 RTTs were recruited to the study. Descriptive statistics demonstrated participant group agreement in conveying treatment instructions, though differing experiences were reported against general conversation. Although the reporting of technical difficulties was inconsistent, both groups recommended the application of the ITD within the RT domain. Conclusion This feasibility study demonstrated encouraging accounts of patients and RTTs with regard to ITD use in the context of RT treatment. Expanded, multi-institutional recruitment is required to yield statistical significance, inform the impact of the device, and determine requisite training requirements. Trial registration HREC reference number: LNR/18/PMCC/115 (18/100L). HREC approval date: 10 July 2018.

Purpose/Objective(s) This feasibility study investigated focal boosts to the DILs and assessed the clinical impact based on physical dose-volume (DV) and biological metrics compared to the non-boost plans. The biological parameters were derived from the planned (DP) and accumulated (DA) DV data of 150 patients with high-risk prostate cancer (HR-PCa). Materials/Methods Ten HR-PCa patients with multiparametric MRI-defined DILs were investigated. Two intensity-modulated proton therapy (IMPT) plans were generated for each patient: one with and the other without focal boost. Evaluation metrics included DV metrics, TCP for DILs and the remaining prostate tissue, and NTCP for the rectum, bladder, and urethra. Data on TCP, NTCP and DV metrics were analyzed using the Wilcoxon signed-rank test (p<0.05). NTCP from QUANTEC (QT) was also used for comparison. A constant relative biological effectiveness (RBE) of 1.1 was assumed for proton therapy. Results A significantly higher Dmean was estimated to the DILs when comparing IMPT-boost (B) to IMPT-non-boost (NB) (IMPT-B: 68.1 GyRBE vs IMPT-NB: 60.8 GyRBE, p<0.01). TCPs for IMPT-B of the prostate-DILs and DILs were higher than for IMPT-NB for α/β of 1.5 and 3 Gy (p<0.001). The Rectal DA-NTCP corresponded to the highest GI toxicity risk of 5.4 % (IMPT-NB) -5.6% (IMPT-B) compared to DP and QT fitted LKB models. The differences in NTCPs were similar for both plans (Table 1). Conclusion Focal dose escalation using IMPT can achieve a higher TCP while keeping the NTCP comparable to that for IMPT-NB plans. The Rectal DA-NTCP resulted in a greater predicted GI toxicity compared to that for DP. The inclusion of DA to predict NTCP accounts for interfraction organ motion and could facilitate the reliability of the predicted toxicity while devising dose escalation strategies in patients with HR-PCa. Table 1: TCP and NTCP for the targets and organs at risk.

Research on how pedagogical content knowledge (PCK)-informed faculty development initiatives can support PCK development among health professions educators is limited. Given the positive impact of PCK on enhancing professional knowledge for effective teaching, this study investigates the learning process of health professions educators in developing their PCK through a faculty development initiative, supported by the Content Representation (CoRe) tool. Using a qualitative approach, grounded in social constructionism, the study engaged eight educators from diverse health disciplines at an Australian university. Participants collaborated in developing and refining PCK-infused lesson plans using the CoRe tool. Several workshops, writing sessions, feedback sharing, and an online community of practice facilitated PCK-related discussion, resource sharing, and networking. Data collection comprised two rounds of individual interviews, written reflections, and lesson planning artefacts. Data were analysed using team-based thematic framework analysis. Four themes were identified: 1) articulating teaching purposes, (2) understanding students’ learning needs, (3) promoting reflection on teaching practice, and (4) challenges in adapting and implementing the CoRe tool. The findings highlight the critical role of faculty development programs and advocate for the use of the CoRe tool for articulating and scaffolding PCK for both experienced and novice educators. The collaborative environment facilitated peer feedback and knowledge sharing, thus fostering a collective understanding of PCK and affirming its relevance within the broader health professions education community.

INTRODUCTION:The transition to qualified practice for health practitioner graduates can be a challenging experience. Supportive transition to practice programs for graduates are typical in nursing, however they are less common in allied health. Investigations into the transition to practice experience of radiation therapist (RT) graduates specifically have been limited. This study aimed to examine the transition to practice experiences of RT graduates in Australia during their first ten months of qualified practice, with the intention to inform the development of fit for purpose transition to practice programs. METHODS:A longitudinal qualitative study was undertaken employing a constructivist grounded theory methodology. Data collection included an online focus group with RT graduates within their first three months of practice; recording of longitudinal audio diaries for six months; and an individual online interview at ten months of qualified practice. RESULTS:Seven RT graduates participated in the study during 2022-2023. Central to the transitional process was 'Becoming the Radiation Therapist' where graduates worked towards assimilating their emerging professional identity. This process was influenced by 'Fitting in' to the team; 'Navigating expectations' of work and the workplace; 'Being supported by experienced others'; and 'Building confidence' through validating experiences. CONCLUSION:The transitional experience of the RT graduate was influenced by their internal identity work, and by the social and structural mechanisms within their workplace. A transition to practice program should include supportive mentoring, intentional exposure to a breadth of experiences, and clear expectations to assist the RT graduate in navigating this challenging period. IMPLICATIONS FOR PRACTICE:The transitional experience can be difficult, and supportive mechanisms throughout the first year of graduate practice would aid the emerging professional identity of the RT graduate and their role within the workplace.

This systematic scoping review explores how Pedagogical Content Knowledge (PCK) is conceptualised and investigated in peer-reviewed empirical studies within higher education. Our results indicate that PCK research in higher education is disparate and varies across countries, disciplines, and focus areas. Although most articles specified the theoretical frameworks in their PCK conceptualisations, significant variations exist regarding included PCK components and interpretations, making comparisons across studies challenging. While most PCK frameworks originated in science disciplines within school education, this review suggests that their general theoretical contributions to PCK have led to their widespread adoption across various disciplines in higher education.

IntroductionBuilding 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.MethodsPractising 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 Industry Specific Item Interpretation for Policy and Strategy were used to analyse and report the results.ResultsSurvey 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.ConclusionThis 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. This exploratory study (n = 121) assessed areas within each research capacity domain where Australian radiation therapists would benefit from extra research assistance, particularly in relation to the workplace and health sector. The study showed within the Organisation and Department domains participants from private sector and metropolitan centres 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; the private sector recorded the highest level of 'no research activity'.image

Background and purposeThis study aimed to investigate the feasibility of safe-dose escalation to dominant intraprostatic lesions (DILs) and assess the clinical impact using dose-volume (DV) and biological metrics in photon and proton therapy. Biological parameters defined as late grade ≥ 2 gastrointestinal (GI) and genitourinary (GU) derived from planned (DP) and accumulated dose (DA) were utilized.Materials and methodsIn total, 10 patients with high-risk prostate cancer with multiparametric MRI-defined DILs were investigated. Each patient had two plans with a focal boost to the DILs using intensity-modulated proton therapy (IMPT) and volumetric-modulated arc therapy (VMAT). Plans were optimized to obtain DIL coverage while respecting the mandatory organ-at-risk constraints. For the planning evaluation, DV metrics, tumor control probability (TCP) for the DILs and whole prostate excluding the DILs (prostate-DILs), and normal tissue complication probability (NTCP) for the rectum and bladder were calculated. Wilcoxon signed-rank test was used for analyzing TCP and NTCP data.ResultsIMPT achieved a higher Dmean for the DILs compared to VMAT (IMPT: 68.1 GyRBE vs. VMAT: 66.6 Gy, p < 0.05). Intermediate–high rectal and bladder doses were lower for IMPT (p < 0.05), while the high-dose region (V60 Gy) remained comparable. IMPT-TCP for prostate-DIL were higher compared to VMAT (IMPT: 86%; α/β = 3, 94.3%; α/β = 1.5 vs. VMAT: 84.7%; α/β = 3, 93.9%; α/β = 1.5, p < 0.05). Likewise, IMPT obtained a moderately higher DIL TCP (IMPT: 97%; α/β = 3, 99.3%; α/β = 1.5 vs. VMAT: 95.9%; α/β = 3, 98.9%; α/β = 1.5, p < 0.05). Rectal DA-NTCP displayed the highest GI toxicity risk at 5.6%, and IMPT has a lower GI toxicity risk compared to VMAT-predicted Quantec-NTCP (p < 0.05). Bladder DP-NTCP projected a higher GU toxicity than DA-NTCP, with VMAT having the highest risk (p < 0.05).ConclusionDose escalation using IMPT is able to achieve a high TCP for the DILs, with the lowest rectal and bladder DV doses at the intermediate–high-dose range. The reduction in physical dose was translated into a lower NTCP (p < 0.05) for the bladder, although rectal toxicity remained equivalent.

Quality communication is critical to the provision of optimal care in radiotherapy. Bi-directional language allows for informed consent, information provision, disclosure of treatment-related health concerns, and active treatment decision making. Globalisation has driven multicultural growth, placing greater demand on multilingual support services. Health systems commonly utilise professional interpreters to overcome language barriers, though issues of access are prevalent. Concurrent development of machine translation technology presents opportunity for an accessible and cost-effective supplement. This study aimed to develop and implement validation methodology to determine clinical suitability and output reliability for radiotherapy application. The study focused solely on English-Mandarin translation – the most common languages spoken in Australian society. This study comprised four domains: 1) critical appraisal of available translator devices, 2) compilation of common phrases, 3) participant recruitment, and 4) device performance testing. Pre-determined English phrases were spoken into the device, with the output Mandarin scored independently by two interpreters utilising a 5-point Likert scale. Analysis entailed descriptive and inferential statistics – employing Pearson’s chi-square test, single proportion hypothesis test and linear regression modelling. A market scan yielded four potential translation devices for review – Travis Translator progressed to validation testing. 188 phrases were collated by the project team; categorized by conversation type and readability score. 1128 validation trials were conducted with six participants. An overall pass rate of 66% (n = 744) was observed – significantly greater than prior research. Uniformity of interpreter scores were evident in 63% of trials; a further 29% constituted a single point variation. Device accuracy improved with repeated use, though colloquialisms and lower readability scores attracted poorer outcomes. This study presents a novel validation methodology for the determination of accuracy and reliability of machine translation. Future research should consider clinical feasibility, training requirements, and expansion to other languages or health disciplines.

Healthcare narratives can be used for education to elicit an emotional or affective response, develop critical thinking, and gain perspective on individuals' experiences with life and illness to cultivate person-centered care. This editorial describes the recent experience of the Journal of Medical Imaging and Radiation Sciences (JMIRS) in developing a new narrative submission format. The processes of engaging and supporting patient authors as well as creating a more accessible submission and review process are presented. Finally, the paper discusses the emerging impact of published narratives and the benefit of working with patients as experts and authors.