AIMS:Differential attainment (DA) in post graduate medical training is a recognised challenge and refers to unexplained variation across groups when split by several protected characteristics. The Royal College of Radiology is committed to fostering diversity, inclusivity, and equality with the goal of narrowing existing gaps and improving training outcomes. MATERIALS AND METHODS:This was a mixed methods study aiming to understand the causes of DA with view to helping the RCR develop strategies to address this. A cross-sectional survey was completed by 140 clinical oncology trainees in September 2022. Trainees and trainers (17 and 6 respectively) from across England, Scotland, Wales and Northern Ireland, took part in focus group and interviews from August to December 2022. Quantitative and qualitative data merged and interpreted. RESULT:Results showed international medical graduates and trainees from ethnic minority backgrounds were more likely to encounter challenges. The qualitative findings were used to identify three themes through which these problems could be framed. The trainee as a "space invader," the hidden curriculum of clinical oncology training and the process of navigating and tacking the training journey. CONCLUSION:Differential attainment is the product of a complex interplay between the trainee, trainer, and the training environment. Therefore, interventions must be tailored to different people and contexts. At a national level, the RCR can adopt general policies to promote this such as mentorship programmes, protected time for supervision and cultural competency training. Efficacy of proposed interventions for trial and their impact on DA should be evaluated to drive evidence-based changes.

A shift of the daily plan can mitigate target position changes that occur between daily MR acquisition and treatment for MR-linac radiotherapy, but increases the session time. We demonstrated that our workflow strategy and decision-making process, to determine whether a subsequent shift is necessary, is appropriate.

T 2 * mapping can be a potential biomarker to characterise hypoxia and monitor treatment response throughout the course of MR-guided radiotherapy on an MR-Linac. This study explores the feasibility of integrating T 2 * mapping in daily prostate MR-Linac workflow using a cohort of patients with prostate cancer. We compared mean T 2 * values within the prostate with repeated measures acquired twice weekly during radiotherapy. T 2 * values at the end of treatment were higher than at the first fraction but didn’t show a consistent trend throughout treatment. Integrating T 2 * mapping with other functional measurements can aid in response based treatment adaptation.

Aims: Prostate morphological changes during external beam radiotherapy are poorly understood. Excellent soft-tissue visualisation offered by magnetic resonance image-guided radiotherapy (MRIgRT) provides an opportunity to better understand such changes. The aim of this study was to quantify prostate volume and dimension changes occurring during extreme and moderately hypofractionated schedules. Materials and methods: Forty prostate cancer patients treated on the Unity 1.5 Tesla magnetic resonance linear accelerator (MRL) were retrospectively reviewed. The cohort comprised patients treated with 36.25 Gy in five fractions (n = 20) and 60 Gy in 20 fractions (n = 20). The volume of the delineated prostates on reference planning computed tomography (fused with MRI) and daily T2-weighted 2-min session images acquired on Unity were charted. Forty planning computed tomography and 500 MRL prostate volumes were evaluated. The mean absolute and relative change in prostate volume during radiotherapy was compared using a paired t-test (P value <0.01 considered significant to control for multiple comparisons). The maximum dimension of the delineated prostate was measured in three isocentric planes. Results: Significant prostate volume changes, relative to MRL imaging fraction 1 (MRL#1), were seen at all time points for the five-fraction group. The peak mean relative volume increase was 21% (P < 0.001), occurring at MRL#3 and MRL#4 after 14.5 and 21.75 Gy, respectively. Prostate expansion was greatest in the superior-inferior direction; the peak mean maximal extension was 5.9 mm. The maximal extension in the left-right and anterior-posterior directions measured 1.1 and 2.2 mm, respectively. For the 20-fraction group, prostate volume increased relative to MRL#1, for all treatment time points. The mean relative volume increase was 11% (P < 0.001) at MRL#5 after 12 Gy, it then fluctuated between 8 and 13%. From MRL#5 to MRL#20, the volume increase was significant (P < 0.01) for 12 of 16 time points calculated. The peak mean maximal extension in the superior-inferior direction was 3.1 mm. The maximal extension in the left-right and anterior-posterior directions measured 1.7 and 3.7 mm, respectively. Conclusion: Significant prostate volume and dimension changes occur during extreme and moderately hypofractionated radiotherapy. The extent of change was greater during extreme hypofractionation. MRIgRT offers the opportunity to reveal, quantify and correct for this deformation. (C) 2022 The Authors. Published by Elsevier Ltd on behalf of The Royal College of Radiologists.

Background to the audit: Docetaxol is used in the management of metastatic prostate cancer. Six cycles are given upfront in hormone sensitive prostate cancer and ten cycles are recommended in castrate resistant disease. ASCO recommends using colony stimulating factors prophylactically when the febrile neutropenia risk is greater than 20%. The dose is 75 mg/m[2] given every three weeks. Many older men at NMUH were given a dose of 65 mg/m[2] to ensure tolerability.

3rd ESTRO Forum 2015 S567The range of doses achieved for D 2cc Rectum was 52.46 Gy to 138.27 Gy. 85% of cases achieved D 10 Urethra of less than 217.5Gy, whilst 100% achieved doses of less than 240 Gy.The range of doses for D 30 Urethra was 172.08 Gy to 222.35 Gy. 64% of cases received doses greater than 188.5Gy but only 7.4% of cases received doses greater than 208 Gy.Only 1 patient required re-catheterisation post procedure. Conclusions:The median dosimetric parameters ascribed to a 145Gy prescription dose were achieved for all GEC-ESTRO described organs at risk, except for the secondary OAR parameter of D 30 Urethra, using a prescription dose of 160Gy.The low rectal doses are noteworthy as is the low rate of recatheterisation.This indicates that 160Gy can be safely delivered which may in turn improve outcomes.