INTRODUCTION:In the management of early-stage breast cancer using radiation therapy, computed tomography (CT) simulation is used to identify the breast conservation surgery (BCS) seroma as a proxy for the tumour bed. The delineation or contouring of the seroma is generally a task performed by a radiation oncologist (RO). With increasing patient numbers and other demands placed on ROs, the scope of practice for radiation therapists (RTs) is continually expanding, and the need for skills transfer from one profession to another has been investigated in recent years. This study aims to compare the BCS seroma volumes contoured by RTs with those contoured by ROs to add evidence in support of expanding the RTs' role in the treatment planning process in the management of early-stage breast cancer.METHODS:A study was undertaken using the CT-simulation (CT-sim) data sets of patients with early-stage breast cancer treated in 2013. The CT-sim data sets had BCS seromas contoured by 1 of 5 ROs as part of routine clinical management. This study involved 4 RTs who each used the patient information to identify and contour breast seromas on 50 deidentified CT-sim data sets. Metrics used to compare RT versus RO contours included volume size, overlap between volumes, and geographical distance from the centre of volumes.RESULTS:There were 50 CT-sim data sets with 1 RO contour and 4 RT contours analysed. The contour volumes of the 4 RTs and the ROs were assessed. Although there were 50 CT-sim data sets presented to each RT, analysis was carried out on 45, 43, 46, and 45 CT-sim data sets. There were no comparisons made where contours were not delineated. The contour volumes of the 4 RTs and the ROs were assessed with an interclass correlation coefficient, with a result of excellent reliability (0.975, 95% [0.963, 0.985]). The DICE similarity coefficient was used to compare the overlap of each RT contour with the RO contour; the results were favourable with mean (95% CI) DSCs 0.685, 0.640, 0.678, and 0.681, respectively. Comparing the RT and RO geographical centre of the seroma volumes, good to excellent reliability between the RTs and ROs was demonstrated (95% CI mean RO vs RT distances (mm): 3.75, 4.99, 7.71, and 3.39). There was no statistically significant difference between the distances (P = 0.65).CONCLUSION:BCS seromas contoured by RTs compared well with those contoured by an RO. This research has provided further evidence to support RTs in assuming additional contouring responsibilities in radiation therapy planning for patients with early-stage breast cancer.

Construction activities involve a lot of risk as workers are exposed to a wide range of job hazards, such as working at height, moving vehicles, toxic substances, and confined spaces. The hazards related to a construction project are mostly unpredictable because construction projects move quickly due to project deadlines, and changing work environments. As a result of this, the industry accounts for one of the highest numbers of work-related claims, and the fourth highest incidence rate of serious claims in Australia. This research investigates how key safety management factors can measure the characteristics of high reliability organisations (HROs) in the construction industry in New South Wales Australia. To address the problem, a model is presented that can predict characteristics of HRO in construction (CHC). Using structural equation modeling (SEM), and confirmatory factor analysis (CFA), the model and measurement instruments are tested and validated from data collected from construction workers. The results identified the factors that effectively measure CHC, and the findings can also be used as a safety management strategy and will contribute to the body of knowledge in research.

The workplace has become a second home to many workers as they spend most of the day working in their various work environment while performing their job roles. It is therefore imperative as a duty of care for employers to ensure they provide a safe workplace for both employees and visitors. In the quest to provide safer working conditions, organizations have continually sort for strategies and successful models from other industries which they can emulate. This has led many organizations to study High Reliability Organizations as an incident prevention strategy. High reliability organizations (HROs) which include air traffic control, nuclear power generation stations and US Navy air carriers, are known to perform their operations in an uncertain and hazardous environment filled with the possibility of failing, and even when they fail they are able to recover quickly. HROs are known to perform nearly incident-free, with high safety and production performance. Research has shown that HROs are able to perform exceptionally well because of their cognitive mindset and collective mindfulness. Collective mindfulness is made up of five aspects present in all HRO which are; preoccupation with failure, reluctance to simplify, sensitivity to operations, commitment to resilience, and deference to expertise. This paper compares workplace incidents in Australia and the United States, using 2016–2018, incident data, extracted from WorkSafe Victoria, SafeWork New South Wales, Workplace Health and Safety Queensland, WorkSafe Western Australia, and the United States Department of Labour, and Occupational Safety and Health Administration websites. We identify falls and being struck by moving object or equipment as the leading cause of workplace accidents, while lack of supervision, non-compliance, training, and the absence of appropriate safety procedures were identified as contributing factors to most workplace accidents. The paper further proposes CM as an incident prevention strategy that can be integrated into organizational safety management systems to mitigate accidents and provide safer working environment.

INTRODUCTION:Computed tomography (CT) simulation is currently used to identify the tumour bed in patients with early stage breast cancer requiring whole-breast and boost radiation therapy. Postlumpectomy breast seromas as visible on CT data have been identified as a proxy for the tumour bed. This study aims to quantify the incidence of postsurgical tumour bed seromas identified at CT simulation and report how well a radiation therapist (RT) is able to identify these seromas compared with those contoured by radiation oncologists (ROs).METHODS AND MATERIALS:A study was undertaken on electronic patient records and the CT-simulation datasets of early stage breast cancer patients treated in 2013 at the Calvary Mater Newcastle to identify the presence of seromas. Patient and tumour characteristics were reviewed. Data analysed included seroma volumes, as contoured by the ROs, as part of the standard voluming procedure. One RT rated seroma visibility based on the level of difficulty when viewing the seroma.RESULTS:Out of 108 CT datasets, an RT was able to identify the presence of a seroma in 102 cases vs. 104 as contoured by ROs. The number of observed agreements was 106 (98.15% of the observations), and the number of agreements expected by chance was 98.4 (91.15% of the observations). The Kappa statistics equalled 0.791 (SE of kappa = 0.143). The strength of agreement is considered to be "substantial."CONCLUSION:RTs play an integral role in contouring during the planning process, and there is scope to expand this role. This research introduced the first step by confirming that a radiation therapist is able to identify seromas on CT-simulation data when compared those contoured by an RO.

The construction industry remains a high-risk industry, because of high fatality rates worldwide. Most construction accidents result from interaction between the work team, workplace, equipment and materials which lead to about 70% of injuries and fatalities. A wide range of safety management approaches have been implemented to manage construction risks, and they have been successful in reducing lost time injuries and incidents. However, a number of safety management approaches currently used in the industry have not kept pace with emerging theory on accident causation, prevention and safety management. To minimise accidents more advanced approaches and methods are required, and one of such methods is High Reliability Organisation (HRO) principles of collective mindfulness. This paper presents a systematic review of HRO research published in construction from 1990–2017. This review aims to identify the possibilities and barriers associated with transferring HRO principles to construction activities. Key findings from seven articles are discussed, research gaps identified and primary outcomes from the data will be presented descriptively.

This study examines the available evidence of high reliability organisational (HRO) theory as a strategy to manage construction safety: (1) Background: High reliability organisations (HROs) have been under investigation by organisational scholars to understand how they function at an exceptionally high level with few or no accidents under challenging circumstances. The construction industry is a high risk industry and is also known for a high fatality rate around the world. This systematic review examines the available evidence of HROs as a strategy to manage construction safety; (2) Methods: A systematic review to summarise and critically appraise the literature on high reliability organisational theory, aimed at improving construction safety; (3) Results: Of 2724 articles found, fifteen studies met the inclusion criteria for qualitative synthesis and review. Six of the studies were from construction, four were from general HROs research, two were from health care, and three were from the aerospace, oil and gas, and nuclear industries; (4) Conclusion: Based on the available evidence, transferring the practices and principles of HROs to construction, the validation of proposed assessing tools and a consensus HRO definitions are the major issues identified.

In recent years, the RetroEMBRACE and EMBRACE studies have undertaken the enormous task of collecting and analyzing clinical and dosimetric data from high-dose rate (HDR) and pulsed-dose rate (PDR) brachytherapy treatments for cervical cancer. Unfortunately there were no centers from Australia and New Zealand that were participants of these studies. The present study aimed to review treatment practices, clinical patient information and dosimetric data from departments within Australia and New Zealand. All centers performing cervical HDR brachytherapy were invited to participate in the study. Each centre was provided with a worksheet that was to be completed for a cross-section of de-identified cervical cancer patients treated at that department. Data requested included: (patient demographics)–age, diagnosis, FIGO staging, high-risk clinical target volume (HR-CTV) value/dimensions,follow up information including local recurrence, distant disease and complications: (treatment practices)–external beam treatment technique, timing of HDR brachytherapy, treatment applicator and imaging used for HDR treatment planning: (dosimetry)–external beam radiation dose/fractionation, HR-CTV dose (D90, D98, D100), Point A dose, Bladder dose (D2cc and ICRU point), Rectal dose (D2cc and ICRU point), Sigmoid dose (D2cc), Vaginal mucosa dose and total reference air kerma (TRAK). Data was analyzed for trends and statistics across all patient information provided. Outliers were contacted to provide additional information in order to better classify results. Approximately 70% of departments contacted provided data for this study. In terms of patient demographics, the average age of treated patients was 49.9 years (range 25 to 88 years) with over half of patients diagnosed with squamous cell carcinoma of the cervix of FIGO stage IIB. Over 95% of patients saw no local recurrence during the follow up period (range 0 to 630 weeks) with almost 80% of patients also having no distant disease or complications. More than 95% of patients were treated once daily with 66% of patients being treated in 3 fractions (evenly split between 1 or 2 fractions per week). Over 85% of HDR treatments were given after the completion of external beam radiation therapy. Almost 90% of departments that responded use volumetric-based prescriptions and 67% of departments use some form of magnetic resonance imaging as part of HDR treatment planning. More than half of the patients had a tandem/ovoid-type applicator inserted for treatment. On average, patients met GEC-ESTRO/ABG EQD2 planning criteria for the target HR-CTV D90 (between 90 and 95 Gy), HR-CTV D98 (> 75 Gy) and Point A (> 65 Gy) and also the bladder D2cc (< 80 Gy), rectum D2cc (<65 Gy) and sigmoid D2cc (< 65 Gy). Approximately half of the departments that responded are also routinely reporting vaginal mucosa dose. There was a significant difference between average Point A doses and the HR-CTV D90 (p < 0.003) and D100 (p < 0.02) doses however the HR-CTV D98 dose was within 5% of the Point A dose. There was also a significant difference between the average bladder D2cc dose and the ICRU bladder dose point (p < 0.05) but this was not the case for the rectal D2cc and ICRU rectal point which were within 5% of each other. Australia and New Zealand radiation oncology departments have embraced volumetric planning and advanced imaging techniques for HDR brachytherapy treatments of cervical cancer. The timing of HDR brachytherapy in these 2 countries results in HR-CTVs that are generally smaller than other published values. Almost all departments in Australia and New Zealand are meeting the GEC-ESTRO/ABS dosimetric planning aims for both the HR-CTV and organs at risk and this is reflected in the clinical outcomes for these patients.

Magnetic resonance imaging (MRI)-based high-dose-rate (HDR) brachytherapy treatment planning for cervix cancer was introduced in the department in 2011. Since that time, all patients have had MRI for every fraction of treatment. A study has been conducted to determine the physical changes to the size of the high-risk clinical target volume (HR-CTV) as brachytherapy treatment progresses and any changes to dosimetry as a result. The treatment records of 56 patients who received HDR brachytherapy using MRI-based treatment planning were assessed. Each patient received 3 fractions, 1 per week of HDR treatment with a total of 168 plans studied. MRI-based plans were generated using a single 3T MR image set (with axis parallel to the intrauterine tube and perpendicular to the ovoids or ring). HR-CTV data as well as dosimetric qualities for each patient plan were gathered and compared for inter-fractional variation. The HR CTV was considered in terms of size and volume with bladder, rectal and sigmoid D2ccdoses also collected. A previous study has already reported that the inter-observer mean variation in HR-CTV contours for the department was 9.2% with a conformity index of 0.80. This has been incorporated into the uncertainty of the statistics presented. On average, the size of the HR-CTV decreased by 5.6 cm3 over the course of brachytherapy, equating to a 22% reduction in the HR-CTV size. This was determined as statistically significant (p<0.02). Only 20% of patients had volumes which increased between fractions however the increase in size was within the measure of uncertainty for HR-CTV contouring in the department. As each fraction was independently planned and optimized for the specific HR-CTV, the HR-CTV D90, bladder, and sigmoid D2cc doses did not significantly change between fractions. Rectal D2cc dose reduced by 9% between brachytherapy fractions. This could be associated with the reduction of the HR-CTV or may be due to changes in rectal filling over the course of treatment. The assumption that the HR-CTV from fraction 1 can be transferred to all HDR brachytherapy fractions may be misguided. In this study, a significant reduction in the HR-CTV was seen between treatment fractions. If this reduction was not taken into consideration during the course of HDR brachytherapy there may have been implications to the organs at risk which lie adjacent to the HR-CTV with an increased risk of over exposing these organs to excessive radiation.

The paper will describe practical ways in which these skills might be of use to clinicians in a radiotherapy setting.

Aim: This study compared the acute toxicities reported during radiotherapy treatment using either intensitymodulated radiation therapy (IMRT) or volumetric-modulated arc therapy (VMAT) to deliver a moderate hypo-fractionated treatment for early-stage prostate cancer.Material and methods: Acute toxicities are routinely reported at the clinical site for all patients using the Common Terminology Criteria for Adverse Events. Toxicity assessment is performed on day 1 of treatment, then once weekly thereafter. The recorded toxicities of 40 cases treated with five-field IMRT, and 32 cases treated using VMAT were retrospectively compared. All cases were prescribed 73.68 Gy in 28 fractions. Eight symptoms were assessed; diarrhoea, proctitis, fatigue, pain, dermatitis, urinary frequency, urinary retention and urinary tract pain.Results: In terms of the overall toxicity recorded, VMAT was shown to reduce the toxicities of dermatitis, fatigue, pain and urinary frequency (p < 0.05). Using IMRT, grade 2 toxicities were reported for proctitis, pain, urinary frequency, urinary retention and urinary tract pain. Using VMAT, grade 2 toxicities were reported for urinary frequency and urinary retention.Findings: The research reported here is one of the first publications to demonstrate that VMAT is associated with decreased toxicities compared with IMRT for the treatment of early-stage prostate cancer.

Introduction: This article presents the results of a single-day census of radiation therapy (RT) treatment and technology use in Australia. The primary aim of the study was to ascertain patterns of RT practice and technology in use across Australia. These data were primarily collated to inform curriculum development of academic programs, thereby ensuring that training is matched to workforce patterns of practice. Methods: The study design was a census method with all 59 RT centres in Australia being invited to provide quantitative summary data relating to patient case mix and technology use on a randomly selected but common date. Anonymous and demographic-free data were analysed using descriptive statistics. Results: Overall data were provided across all six Australian States by 29 centres of a possible 59, yielding a response rate of 49% and representing a total of 2743 patients. Findings from this study indicate the increasing use of emerging intensity-modulated radiotherapy (IMRT), image fusion and image-guided radiation therapy (IGRT) technology in Australian RT planning and delivery phases. IMRT in particular was used for 37% of patients, indicating a high uptake of the technology in Australia when compared to other published data. The results also highlight the resource-intensive nature of benign tumour radiotherapy. Conclusions: In the absence of routine national data collection, the single-day census method offers a relatively convenient means of measuring and tracking RT resource utilisation. Wider use of this tool has the potential to not only track trends in technology implementation but also inform evidence-based guidelines for referral and resource planning.

Introduction: This study compared four different volumetric modulated arc therapy (VMAT) beam arrangements for the treatment of early-stage prostate cancer examining plan quality and the impact on a radiotherapy department's resources. Methods: Twenty prostate cases were retrospectively planned using four VMAT beam arrangements (1) a partial arc (PA), (2) one arc (1A), (3) one arc plus a partial arc (1A + PA) and (4) two arcs (2A). The quality of the dose distributions generated were compared by examining the overall plan quality, the homogeneity and conformity to the planning target volume (PTV), the number of monitor units and the dose delivered to the organs at risk. Departmental resources were considered by recording the planning time and beam delivery time. Results: Each technique produced a plan of similar quality that was considered adequate for treatment; though some differences were noted. The 1A, 1A + PA and 2A plans demonstrated a better conformity to the PTV which correlated to improved sparing of the rectum in the 60-70 Gy range for the 1A + PA and 2A techniques. The time needed to generate the plans was different for each technique ranging from 13.1 min for 1A + PA to 17.8 min for 1A. The PA beam delivery time was fastest with a mean time of 0.9 min. Beam-on times then increased with an increase in the number of arcs up to an average of 2.2 min for the 2A technique. Conclusion: Which VMAT technique is best suited for clinical implementation for the treatment of prostate cancer may be dictated by the individual patient and the availability of departmental resources.

Poster: 2014 CSM / R-0130 / SNAPSHOT: A census of radiotherapy practice in Australia by: P. Bridge 1, M.-A. Carmichael1, C. Opie2, E. Giles3, S. Dempsey4; 1BRISBANE/AU, 2SYDNEY/AU, 3ADELAIDE/AU, 4NEWCASTLE/AU

As radiation therapy transitions from intensity modulated radiation therapy (IMRT) to volumetric modulated arc therapy (VMAT) it is important to consider the quality assurance (QA) of VMAT plans in light of what has previously been learned and developed in IMRT QA. This technical note assesses if IMRT based plan QA software, which has reduced the need in IMRT for phantom dose measurements on the linear accelerator, can be incorporated into VMAT QA processes. Twenty prostate cases were retrospectively planned using VMAT with one arc to deliver a prescription of 74 Gy in 37 fractions. A plan QA was performed using both IMSure (version 3.3), a software-based IMRT QA program, and ArcCHECK (version 6.2.3.5713), a phantom-based VMAT QA tool. Outcomes assessed included the time needed to perform the QA of both the IMSure and ArcCHECK QA methods, and agreement between planned dose and QA measured dose. On average per case, the ArcCHECK technique needed 31.5 min to perform the VMAT plan QA, while IMSure required 3.5 min to perform the same QA. All 20 cases passed dosimetric QA using ArcCHECK. However, using IMSure, three cases failed dosimetric QA using the departments existing IMRT QA criteria. This research has demonstrated that the IMRT QA software IMSure may be incorporated into the QA of VMAT plans, however the criteria to assess the dosimetry of the VMAT plans may need to be different to that for IMRT cases. The implication of this research for radiation therapists is to be critically aware of the differences between the plan QA requirements and methods for IMRT and those required for VMAT.

Magnetic resonance (MR)-based treatment planning in cervix brachytherapy has seen a shift in the way that treatment is prescribed and also to some extent the actual dose prescribed. The purpose of this study was to evaluate the changing nature of cervix brachytherapy dosimetry in a single centre with the introduction of MR-based treatment planning. The treatment records of 69 patients treated with curative intent for cervical cancer and receiving HDR brachytherapy treatment were reviewed retrospectively. 41 patients were planned using computed tomography (CT)-based images only and optimized and prescribed based on traditional Point A doses. 28 patients were planned using MR-based brachytherapy with a HR-CTV contoured on each plan. Dose was optimized to the high-risk clinical target volume (HR-CTV) and prescribed to the 100% isodose in these patients. Both CT and MR- based plans were assessed for Point A dose and doses to organs at risk (OAR) including the bladder and rectum with additional HR-CTV dose assessment for MR-based brachytherapy plans. Both ICRU-38 point doses and GEC-ESTRO recommended volumes (D2cc for OAR and D100 and D90 for HR-CTV) were considered and biological equivalent doses for 2 Gy fractions (EQD2) using the linear quadratic (LQ) model with an α/β = 3 for OAR and an α/β = 10 for target dose were determined. The average volume of the HR CTV in this study was below published volumes at 21 (± 9) cm3. Due to these small volumes, Point A dose dropped on average by 4.8 Gy (p<0.0008) from CT-based plans. The overall mean rectal dose reduced from 75.2 Gy (CT) to 67.7 Gy (MR) for the ICRU point and 74.5 Gy (CT)to 67.7 Gy (MR) D2cc dose. The overall mean bladder dose reduced from 98.0 Gy (CT) to 92.6 Gy MR) for the ICRU point and 105.9 Gy (CT)to 89.9 Gy (MR) for the D2cc dose. Each reduction was statistically significant (p <0.01) with the exception of the bladder ICRU dose. Average Point A doses for MR-based brachytherapy treatment plans were closer to, and correlated with, those of HR-CTV D100 (29.5 Gy) rather than the HR-CTVD90 (48.4 Gy), with a significant difference between Point A and D90 doses. Current recommendations are the traditional prescription dose at Point A to become the dose given to the HR-CTV D90,. For small HR-CTV (20 cm3 and below) this leads to a reduction in Point A dose of up to 30%. The authors suggest basing prescription doses on the HR CTV D100 or D98 in these instances until larger follow-up studies (eg. EMBRACE) are completed. Effectively this provides a 'dose escalation' to the HR-CTV whilst minimising the differences between historical prescription points that have robust and well-known treatment outcomes. For HR-CTV volumes above 20 cm3, the recommendation of prescribing to the HR-CTV D90 appears appropriate.

Purpose Student experience on clinical placement is not well captured with traditional program evaluation tools. This study aims to complete a qualitative analysis of the reflective clinical journals completed during professional placement by radiation therapy (RT) students in order to uncover the issues that affect students on placement and how these change as the student's progress through the program. Materials and methods A qualitative descriptive analysis (QDA) was undertaken on the descriptive content of student journals completed by 97 students over 3 consecutive years while undertaking professional placement in Radiation Oncology Treatment Centres within Australia. Two coders used a QDA sourcebook specifically designed for the research to independently analyse the descriptive content of the reflective journals for four main categories and 18 subcategories. Results The result revealed a statistically significant increased tendency to discuss clinical environment and a decreased tendency to discuss the patient, 92·9–12·5% (coder 1) and 85·7–18·8% (coder 2), as they progressed through the program. Conclusions The results of this study showed some similarities with studies completed in other health professions; however, the breadth of issues explored within the content of these RT student journals demonstrates the true diversity of the RT student experience on professional placement.

Poster: 2014 CSM / R-0095 / A single-centre retrospective analysis of the incidence of seromas post-lumpectomy in patients requiring radiation therapy for the management of breast cancer by: S. Oultram , S. Dempsey; NEWCASTLE/AU

Introduction: The primary aim of this study is to compare intensity modulated radiation therapy (IMRT) to volumetric modulated arc therapy (VMAT) for the radical treatment of prostate cancer using version 10.0 (v10.0) of Varian Medical Systems, RapidArc radiation oncology system. Particular focus was placed on plan quality and the implications on departmental resources. The secondary objective was to compare the results in v10.0 to the preceding version 8.6 (v8.6). Methods: Twenty prostate cancer cases were retrospectively planned using v10.0 of Varian's Eclipse and RapidArc software. Three planning techniques were performed: a 5-field IMRT, VMAT using one arc (VMAT-1A), and VMAT with two arcs (VMAT-2A). Plan quality was assessed by examining homogeneity, conformity, the number of monitor units (MUs) utilized, and dose to the organs at risk (OAR). Resource implications were assessed by examining planning and treatment times. The results obtained using v10.0 were also compared to those previously reported by our group for v8.6. Results: In v10.0, each technique was able to produce a dose distribution that achieved the departmental planning guidelines. The IMRT plans were produced faster than VMAT plans and displayed improved homogeneity. The VMAT plans provided better conformity to the target volume, improved dose to the OAR, and required fewer MUs. Treatments using VMAT-1A were significantly faster than both IMRT and VMAT-2A. Comparison between versions 8.6 and 10.0 revealed that in the newer version, VMAT planning was significantly faster and the quality of the VMAT dose distributions produced were of a better quality. Conclusion: VMAT (v10.0) using one or two arcs provides an acceptable alternative to IMRT for the treatment of prostate cancer. VMAT-1A has the greatest impact on reducing treatment time.