Abstract Background In healthcare, regulation of professions is an important tool to protect the public. With increasing regulation however, professions find themselves under increasing scrutiny. Recently there has also been considerable concern with regulator performance, with high profile reports pointing to cases of inefficiency and bias. Whilst reports have often focused on large staff groups, such as doctors, in the literature there is a dearth of data on the experiences of smaller professional groups such Clinical Scientists with their regulator, the Health and Care Professions Council. This article reports the findings of a survey from Clinical Scientists (Physical Sciences modality) about their experiences with their regulator, and their perception of the quality and safety of that regulation. Methods Between July–October 2022, a survey was conducted via the Medical Physics and Engineering mail-base, open to all medical physicists & engineers. Questions covered typical topics of registration, communication, audit and fitness to practice. The questionnaire consisted of open and closed questions. Likert scoring, and thematic analysis were used to assess the quantitative and qualitative data. Results Of 146 responses recorded, analysis was based on 143 respondents. Overall survey sentiment was significantly more negative than positive, in terms of regulator performance (negative responses 159; positive 106; significant at p < 0.001). Continuous Professional Development audit was rated median 4; other topics were rated as neutral (fitness to practice, policies & procedures); and some as poor (value). Conclusions The Clinical Scientist (Physical Sciences) professional registrants rated the performance of their regulator more negatively than other reported assessments (by the Professional Standards Authority). Survey respondents suggested a variety of performance aspects, such as communication and fitness to practice, would benefit from improvement. Indications from this small dataset, suggest a larger survey of HCPC registrants would be useful.

Journal of Magnetic Resonance ImagingEarly View Editorial Editorial for "Auditory Effects of Acoustic Noise from 3-T Brain MRI in Neonates With Hearing Protection" Mark McJury PhD, FIPEM, Mark McJury PhD, FIPEM orcid.org/0000-0001-7625-8284 University of Glasgow, Imaging Centre of Excellence, Queen Elizabeth University Hospital Campus, Glasgow, Scotland, UKSearch for more papers by this authorFrank G. Shellock PhD, FACR, FISMRM, FACC, Corresponding Author Frank G. Shellock PhD, FACR, FISMRM, FACC [email protected] orcid.org/0000-0002-6823-6031 Keck School of Medicine, University of Southern California, Los Angeles, California, USASearch for more papers by this author Mark McJury PhD, FIPEM, Mark McJury PhD, FIPEM orcid.org/0000-0001-7625-8284 University of Glasgow, Imaging Centre of Excellence, Queen Elizabeth University Hospital Campus, Glasgow, Scotland, UKSearch for more papers by this authorFrank G. Shellock PhD, FACR, FISMRM, FACC, Corresponding Author Frank G. Shellock PhD, FACR, FISMRM, FACC [email protected] orcid.org/0000-0002-6823-6031 Keck School of Medicine, University of Southern California, Los Angeles, California, USASearch for more papers by this author First published: 28 May 2024 https://doi.org/10.1002/jmri.29451 Level of Evidence: 5. Technical Efficacy: Stage 1. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat No abstract is available for this article. References 1McJury MJ. Acoustic noise and magnetic resonance imaging: A narrative/descriptive review. J Mag Reson Imaging 2022; 55: 337-346. 10.1002/jmri.27525 PubMedWeb of Science®Google Scholar 2Anderssen SH, Nicolaisen RB, Gabrielsen GW. Autonomic response to auditory stimulation. Acta Paediatr 1993; 82: 913-918. 10.1111/j.1651-2227.1993.tb12598.x CASPubMedWeb of Science®Google Scholar 3Philbin MK, Taber KH, Hayman LA. Preliminary report: Changes in vital signs of term newborns during MR. Am J Neurorad 1996; 17: 1033-1036. CASPubMedWeb of Science®Google Scholar 4White RD, Smith JA, Shepley MM. Recommended standards for newborn ICU design. J Perinatol 2013; 33: S2-S16. 10.1038/jp.2013.10 PubMedWeb of Science®Google Scholar 5Ravicz ME, Melcher JR, Kiang NYS. Acoustic noise during functional MRI. J Acoust Soc Am 2000; 108: 1683-1696. 10.1121/1.1310190 CASPubMedWeb of Science®Google Scholar 6 Medicines and Healthcare Products Regulatory Authority (MHRA). Safety guidelines for magnetic resonance imaging equipment in clinical use. United Kingdom: Medicines and Healthcare Products Regulatory Authority (MHRA); 2015. Google Scholar 7 U.S. Food and Drug Administration. Criteria for significant risk investigations of magnetic resonance diagnostic devices. Guidance for industry and food and drug administration staff. Rockville, MD: Food and Drug Administration Center for Devices and Radiological Health; 2014. Google Scholar 8 International Electrotechnical Commission. Medical electrical equipment-Part 2–33: Particular requirements for the basic safety and essential performance of magnetic resonance equipment for medical diagnosis. 60601–2-33-2022: International Electrotechnical Commission; 2022. Google Scholar 9Hill Beluk N, Lee VK, Shellock FG. MRI evaluation of a hearing protector device designed for neonatal patients. J Radiol Nursing 2022; 41: 193-200. 10.1016/j.jradnu.2022.04.004 Google Scholar 10Jin C, Zhao H, Li H, et al. Auditory effects of acoustic noise from 3-T brain MRI in neonates with hearing protection. J Magn Reson Imaging 2024. https://doi.org/10.1002/jmri.29450. 10.1002/jmri.29450 Google Scholar Early ViewOnline Version of Record before inclusion in an issue ReferencesRelatedInformation

Purpose or ObjectiveRegional failure in nasopharyngeal carcinoma (NPC) is managed by salvage treatment in the form of neck dissection.Radical neck dissection (RND) is preferred over modified radical neck dissection (MRND), since it is traditionally believed to offer better long term disease control.However, with the advent of more advanced imaging modalities like high-resolution Magnetic Resonance Imaging, Computed Tomography and Positron Emission Tomography-CT scans, earlier detection is achieved.Additionally, concurrent chemotherapy also contributes to reduced tumour burden.Hence, there may be a lesser need for a RND and a greater role for MRND.With this retrospective study, the primary aim is to ascertain whether MRND, as opposed to RND, has similar outcomes and hence, whether there would be more grounds to offer a less aggressive procedure to achieve lower patient morbidity. Material and MethodsThis is a retrospective study of 66 NPC patients treated at Singapore General Hospital between 1994 to 2016 for histologically proven regional recurrence, of which 41 patients underwent RND and 25 who underwent MRND, based on surgeon preference.The type of ND performed, primary treatment mode, adjuvant treatment and pattern of recurrence was reviewed.Overall survival (OS) was calculated using Kaplan-Meier estimate and compared. ResultsOverall, the disease parameters such as nodal involvement and extranodal extension were comparable between the two groups.Comparing MRND and RND, the median (IQR) OS is 1.76 (0.58 to 3.49) and 2.41 (0.78 to 4.11) respectively.However, the p-value found is 0.5301 and hence not statistically significant. ConclusionRND is more aggressive and has been associated with greater morbidity.Hence, with similar outcomes, MRND could be an alternative salvage procedure for regional failure in selected NPC patients, allowing similar salvage rates with lesser mortality and morbidity.

INTRODUCTION AND BACKGROUND:A significant proportion of patients with intermediate and high risk squamous cell cancer of the oropharynx (OPSCC) continue to relapse locally despite radical chemoradiotherapy (CRT). The toxicity of the current combination of intensified dose per fraction radiotherapy and platinum based chemotherapy limits further uniform intensification. If a predictive biomarker for outcomes from CRT can be identified during treatment then individualised and adaptive treatment strategies may be employed.METHODS/DESIGN:The MeRInO study is a prospective observational imaging study of patients with intermediate and high risk, locally advanced OPSCC receiving radical RT or concurrent CRT Patients undergo diffusion weighted MRI prior to treatment (MRI_1) and during the third week of RT (MRI_2). Apparent diffusion coefficient (ADC) measurements will be made on each scan for previously specified target lesions (primary and lymph nodes) and change in ADC calculated. Patients will be followed up and disease status for each target lesion noted. The primary aim of the MeRInO study is to determine the threshold change in ADC from baseline to week 3 of RT that may identify the sub-group of non-responders during treatment.DISCUSSION:The use of DW-MRI as a predictive biomarker during RT for SCC H&N is in its infancy but studies to date have found that response to treatment may indeed be predicted by comparison of DW-MRI carried out before and during treatment. However, previous studies have included all sub-sites and biological sub-types. Establishing ADC thresholds that predict for local failure is an essential step towards using DW-MRI to improve the therapeutic ratio in treating SCC H&N. This would be done most robustly in a specific H&N sub-site and in sub-types with similar biological behaviour. The MeRInO study will help establish these thresholds in OPSCC.

OBJECTIVE A clinical evaluation of the intrafraction and interfraction setup accuracy of a novel thermoplastic mould immobilization device and patient position in early-stage lung cancer being treated with stereotactic radiotherapy at the Beatson West of Scotland Cancer Centre, Glasgow, UK. METHODS 35 patients were immobilized in a novel, arms-down position, with a four-point Klarity™ (Klarity Medical Products, Ohio, US) clear thermoplastic mould fixed to a SinMed (CIVCO Medical solutions, lowa, US) head and neck board. A knee support was also used for patient comfort and support. Pre- and post-treatment kilovoltage cone beam CT (CBCT) images were fused with the planning CT scan to determine intra- and interfraction motion. A total of 175 CBCT scans were analysed in the longitudinal, vertical and lateral directions. RESULTS The mean intrafraction errors were 0.05 ± 0.77 mm (lateral), 0.44 ± 1.2 mm (superior-inferior) and -1.44 ± 1.35 mm (anteroposterior), respectively. Mean composite three-dimensional displacement vector was 2.14 ± 1.2 mm. Interfraction errors were -0.66 ± 2.35 mm (lateral), -0.13 ± 3.11 mm (superior-inferior) and 0.00 ± 2.94 mm (anteroposterior), with three-dimensional vector 4.08 ± 2.73 mm. CONCLUSION Setup accuracy for lung image-guided stereotactic ablative radiotherapy using a unique immobilization device, where patients have arms by their sides, has been shown to be safe and favourably comparable to other published setup data where more complex and cumbersome devices were utilised. There was no arm toxicity reported and low arm doses. Advances in knowledge: We report on the accuracy of a novel patient immobilization device.

The purpose of this study was to demonstrate how magnetic resonance imaging (MRI) patient position protocols influence registration quality in patients with oropharyngeal cancer undergoing radical radiotherapy and the consequences for gross tumour volume (GTV) definition and radiotherapy planning.

Purpose/Objective: Modern radiotherapy techniques such as IMRT and VMAT allow physicians to spare organs at risk of radiotherapy damage thereby improving quality of life (QoL) amongst survivors.In patients undergoing radical radiotherapy (RRT) for head and neck cancer, dose to SWOAR is increasingly being recognised as a determinant of QoL and long-term function such as dysphagia, regurgitation and tube dependency.Therefore, it has been proposed that limiting dose to SWOAR would be a desirable goal.However, there is no data on dosimetry of SWOAR during treatment or whether changes are potentially due to tumour response or inflammation thereby, supporting a strategy of enforcing strict dose constraints.This study aimed to document dosimetry of SWOAR using midway planning CT scan, whilst applying the original treatment plan as well as an adaptive plan generated de novo.Materials and Methods:  27 consecutive patients with head and neck cancer were CTsimulated (SCAN 1) and a VMAT treatment plan (PLAN1) was generated to treat to a dose of 65Gy in 30 fractions (#).Patients completed treatment based on this plan. Mid-treatment ie week 3, patients underwent a second CTsimulation to acquire mid treatment planning image (SCAN2) Retrospectively, the original treatment PLAN 1 was applied to the mid-treatment SCAN2 to create PLAN 2 In addition, a de novo plan or PLAN (ART) was generated using SCAN 2 but with the optimisation priorities and constraints unchanged from the first PLAN 1(this second plan was aimed to treat last 10 treatments to 21.67Gy in 10#)  Delineation of SWOARs was performed for Base of tongue (BOT), oesophageal inlet muscle (EIM), superior/middle/inferior pharyngeal constrictor muscle (SPCM/MPCM/IPCM), cricopharyngeal muscle (Crico), cervical oesophagus (CEso), supra-larynx and glottic larynxfor both treatment planning SCAN 1 and SCAN 2 and mean and median dose to each SWOAR was obtained.A paired t-test was used to compare the dose to SWOAR between PLAN1 (clinical plan 30#) and PLAN1(20#) PLAN2(10#) to identify if there was a significant difference when a recalculation was performed and delivered for remaining 10#.This was repeated to evaluate a significant difference when PLAN ART was to be used for remaining 10#.Results: Overall there was little difference in dosimetry to SWOAR whether treatment proceeded using the original plan recalculated (PLAN 2) or an adaptive plan generated de novo to optimise for PTV coverage (PLAN ART).The only significant difference was seen for Crico p=0.04,SPCM p=0.01 and EIM p=0.04 for PLAN 2 and for the Crico p=0.01 for PLAN ART used in conjunction with an adaptive plan.

OBJECTIVETo investigate the necessity of performing MRI in the radiotherapy position when using MRI for prostatic radiotherapy.METHODS20 prostate patients received a CT, diagnostic MRI and an MRI scan in the radiotherapy position. The quality of registration between CT and MRI was compared between the two MRI set-ups. The prostate and seminal vesicles were contoured using all scans and intensity modulated radiotherapy (IMRT) plans were generated. Changes in the target volume and IMRT plans were investigated. Two-tailed paired Student's t-tests determined the statistical significance.RESULTSThere was a decrease in the mean distance from the centre of the bony anatomy between CT and MRI (from 3.9 to 1.9 mm, p-value<0.0001) when the MRI scan was acquired in the radiotherapy position. Assuming that registering CT with an MRI scan in the radiotherapy position is the gold standard for delineating the prostate and seminal vesicles, using a planning target volume delineated on the CT with a diagnostic MRI scan viewed separately, resulted in a mean conformation number of 0.80 instead of the expected 0.98 (p<0.0001).CONCLUSIONBy registering CT with an MRI scan in the radiotherapy position, there is a statistically significant improvement in the registration and IMRT quality.ADVANCES IN KNOWLEDGETo achieve an acceptable registration and IMRT quality in prostatic radiotherapy, neither CT with a separate diagnostic MRI nor CT registered to a diagnostic MRI will suffice. Instead, a CT registered with an MRI in the radiotherapy position should be used.

OBJECTIVESTo improve the integration of MRI with radiotherapy treatment planning, our department fabricated a flat couch top for our MR scanner. Setting up using this couch top meant that the patients were physically higher up in the scanner and, posteriorly, a gap was introduced between the patient and radiofrequency coil.METHODSPhantom measurements were performed to assess the quantitative impact on image quality. A phantom was set up with and without the flat couch insert in place, and measurements of image uniformity and signal to noise were made. To assess clinical impact, six patients with pelvic cancer were recruited and scanned on both couch types. The image quality of pairs of scans was assessed by two consultant radiologists.RESULTSThe use of the flat couch insert led to a drop in image signal to noise of approximately 14%. Uniformity in the anteroposterior direction was affected the most, with little change in right-to-left and feet-to-head directions. All six patients were successfully scanned on the flat couch, although one patient had to be positioned with their arms by their sides. The image quality scores showed no statistically significant change between scans with and without the flat couch in place.CONCLUSIONAlthough the quantitative performance of the coil is affected by the integration of a flat couch top, there is no discernible deterioration of diagnostic image quality, as assessed by two consultant radiologists. Although the flat couch insert moved patients higher in the bore of the scanner, all patients in the study were successfully scanned.

Respiratory motion complicates target volume definition for patients with lung cancer. The use of slow CT to aid in the definition of moving target volumes was investigated. Standard and slow scans of an oscillating phantom were acquired using gantry rotation periods of 0.8 and 1.5 s and pitches of 0.95 and 0.50, respectively. The resultant images of three spheres within the phantom, labelled as A, B and C with diameters of 3.7, 2.8 and 2.2 cm, were analysed. The central co-ordinates of each volume were determined, and the ratio of the target volume outlined on CT (TV(CT)) to the true target volume (TV) was calculated. For 1.5 cm peak-to-trough (PTT) motion, standard CT mean ratios of 0.8, 0.8 and 0.7 were obtained for spheres A, B and C, respectively, whereas slow CT resulted in a mean ratio of 0.9 for all three spheres. For 2.5 cm motion, standard CT mean ratios of 0.8, 0.7 and 0.7 were obtained, whereas the slow CT mean ratios were 0.9, 0.9 and 0.8. The deviation of the central co-ordinate for the slow CT volumes was within 0.1 cm whereas deviations of up to 0.7 cm were seen using standard CT. This study indicates the potential benefit of using slow CT, even on modern scanners capable of rotation periods only down to 1.5 s, to define moving target volumes more accurately and reproducibly moving target volumes, and aid in the management of respiratory motion for patients with lung cancer.

A computer model of broad beam transmission through lead material for γ

Background and purpose: Currently, optimal use of virtual simulation for all treatment sites is not entirely clear. This study presents data to identify specific patient groups for whom conventional simulation may be completely eliminated and replaced by virtual simulation.Sampling and method: Two hundred and sixty patients were recruited from four treatment sites (head and neck, breast, pelvis, and thorax). Patients were randomly assigned to be treated using the usual treatment process involving conventional simulation, or a treatment process differing only in the replacement of conventional plan verification with virtual verification. Data were collected on set-up accuracy at verification, and the number of unsatisfactory verifications requiring a return to the conventional simulator. A micro-economic costing analysis was also undertaken, whereby data for each treatment process episode were also collected: number and grade of staff present, and the time for each treatment episode.Results: The study shows no statistically significant difference in the number of returns to the conventional simulator for each site and study arm. Image registration data show similar quality of verification for each study arm. The micro-costing data show no statistical difference between the virtual and conventional simulation processes.Conclusions: At our institution, virtual simulation including virtual verification for the sites investigated presents no disadvantage compared to conventional simulation.