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The purpose of this project was to develop and implement a new national training curriculum for radiation oncology. Rapid advances in radiation techniques, and increased expansion of services in our country required a new curriculum to reflect radiation oncology practice in the modern era. Once established and ratified by the training faculty, the aim was to introduce the new curriculum into clinical practice across all training sites. An educational subcommittee of the Faculty of Radiologists Radiation Oncology Committee was established. This included representation from faculty members, the National Training Coordinator, the local training coordinators, and two trainee representatives. The National Medical Council's 8 domains of good clinical practice were taken as a basis on which to build the new curriculum. This is to ensure trainees develop a professional approach to work, rather than focusing on clinical aspects alone. International guidelines from the US, Canada, UK, Australia, and ESTRO were all reviewed to guide the clinical content of the program. Grant's 6 steps of curriculum design were utilized. The new training curriculum has been implemented as of July 2021. There is a clear roadmap for trainees to guide them through its clinical and non-clinical aspects. Requirements to pass through each of the 5 years (full-time equivalent) of training are outlined. Trainees develop progressive expertise in the use of radiotherapy to treat patients with all cancer types. This starts with management of oncological emergencies in first year and progresses to include advanced techniques including SABR and brachytherapy. A newly-developed standardized logbook was established for recording radiotherapy planning experience. Workplace based assessments were introduced (including Direct Observation of Radiotherapy Planning skills), initially a minimum number of non-site specified assessments per year was stipulated, with a view to expanding this over the coming years. A list of non-clinical training commitments is now in place, including Problem-Based Learning and Human Factors courses. These aim to develop communication, management and leadership skills. The examination process remains unchanged and is directly associated with another national training program. Satisfactory completion of exams leads to conferring with the Fellowship of the Faculty of Radiologists Royal College of Surgeons (FFR RCSI) Satisfactory completion of training will lead to Certificate of Completion of Specialist Training which permits the doctor to register on the Specialist Division of the Medical Council and to practice independently as a radiation oncologist. A modern attainable training curriculum was implemented which reflects the 8 domains of good clinical practice. The clinical content is in keeping with the highest international standards allowing international recognition of qualifications [ABSTRACT FROM AUTHOR]

We are an academic radiation oncology center and treat 1500-2000 patients annually. The majority of target volume definition and organ at risk (OAR) contouring is performed by radiation oncologists (RO) and is estimated to require 10-15 hours per week for each RO. Artificial intelligence (AI) solutions for contouring are a possible method of reducing the time required. Several packages are commercially available. The purpose of this exercise was to evaluate 4 packages to identify one which would meet our department's need. The primary objective was to calculate the potential time savings associated with each of the 4 packages. The second objective was to perform a qualitative evaluation and comparison. Approval from the hospital's Research Ethics Committee was obtained. CT Simulation datasets for 15 patients were anonymized for use as test cases for AI contouring. This included 5 datasets from each of 3 sites – head and neck (H+N), breast/thorax, and prostate/pelvis. 4 potential vendors provided access to their product for automated contouring of OARs +/- target volumes of each of the 15 datasets. Analysis was as follows: 1. One RO used a stopwatch to assess the time taken for them to contour each of the OARs +/- targets on each dataset 2. The AI contours from each of the vendors for each of the datasets was reviewed. 3. The time taken to correct each auto-contoured organ to make it clinically useful was timed. These times were summed to give an overall time for each vendor for each dataset. 4. The absolute time saving was calculated by subtracting the result of step (3) from step (1) 5. The percentage time saving was calculated by dividing this value by the baseline time for contouring by the RO 6. For the purpose of qualitative assessment, 2 ROs reviewed each dataset and assigned an objective score of 1-5 to each auto- contoured organ (e.g., 5 = no, or almost no, edits required; clinically useful as is) 7. The scores for each organ in each of the 15 datasets were averaged to give a mean value for the software package. Baseline contouring time was 32.8 minutes for H+N, 23.0 minutes for breast/thorax, and 64.8 minutes for prostate/pelvis. One package was removed from consideration after assessment of H+N only as it was deemed to be of insufficient standard to be of clinical use. The average time savings for each of the remaining 3 software packages were 15.7, 17.9, and 12.8 minutes for H+N, 3.1, 13.1, and 11.0 minutes for breast/thorax, and 32.6, 35.2, and 36.2 minutes for prostate/pelvis. Percentage time savings ranged from 39-55% for H+N, 13-57% for breast/thorax, and 50-56% for prostate/pelvis. The overall qualitative assessments on a 5-point scale were 3.5, 4.0, and 3.6. The AI contouring solutions were associated with meaningful savings in the time taken to contour. The introduction of one of these products into clinical practice within our department will permit ROs to focus more of their time on other clinical activities. [ABSTRACT FROM AUTHOR]

The primary aim of this trial was to compare the incidence of grade 2 or above acute gastrointestinal (GI) toxicity for patients undergoing 3DCRT versus IMRT in the preoperative setting for locally-advanced rectal cancer. Secondary objectives included quality of life and other acute and late toxicity. The trial was designed to have 80% power to detect a difference between a hypothesized 37% acute toxicity rate in the 3DCRT arm (Bosset et al, 2006) and 20% in the IMRT arm, with a sample size of 120 per arm, and a 0.05 two-sided level of significance. Eligible participants were adults aged 18 or over scheduled to receive pre-operative pelvic chemo-radiotherapy for histologically-confirmed rectal adenocarcinoma. Exclusion criteria included prior pelvic radiotherapy, inflammatory bowel disease, hip replacements, and previous bowel surgery. Prescription dose was 50.4 Gray in 28 fractions over 5.5 weeks with concurrent 5-fluorouracil or capecitabine chemotherapy. Participants were centrally randomized 1:1 to receive 3DCRT or IMRT. Each individual radiotherapy volume and plan was reviewed centrally to ensure compliance with the trial's RTQA specifications. Toxicity was graded and reported according to CTCAE version 4.0 (National Institutes of Health National Cancer Institute). Acute toxicity was assessed weekly during radiotherapy, and at 2- and 4-weeks post-treatment. 94 patients were enrolled. 77% were male and median age was 59.4. Two participants from the 3DCRT arm did not complete radiotherapy as planned and were excluded from analysis. 25 (56%) of participants from the 3dCRT arm and 23 (49%) from the IMRT arm experienced acute grade 2 or above GI toxicity (p=.670). Rates for grade 3 GI toxicity were 8 (18%) and 5 (11%) for 3dCRT and IMRT, respectively (p=.494). Grade 3 GI events included diarrhea (n=11), nausea (n=2), intestinal obstruction (n=1), oral mucositis (n=1), and rectal pain (n=1). The study closed early due to absence of evidence of a difference between arms at the interim analysis. No significant difference in rates of acute GI toxicity with IMRT versus 3DCRT for locally advanced rectal cancer was seen. Although IMRT can reduce dose to organs at risk, it appears to be similarly safe in terms of acute GI toxicity to deliver this treatment with 3DCRT. [ABSTRACT FROM AUTHOR]

Neoadjuvant radiotherapy is an integral part of the management of locally advanced rectal cancer. Radiotherapy can be delivered using three-dimensional conformal radiotherapy (3DCRT) and intensity-modulated radiotherapy (IMRT) techniques. We herein compare the quality-of-life (QOL) outcomes of patients who received radiotherapy using these techniques in a randomised trial. A phase II randomised trial was conducted in patients with locally advanced rectal cancer. Patients staged as T3-4, N (any), or circumferential resection margin at risk were eligible. All patients underwent neoadjuvant chemoradiotherapy with 50.4 Gy given in 28 fractions with concomitant fluorouracil or capecitabine. Patients were randomly allocated, in a 1:1 ratio, to 3DCRT or IMRT planning techniques. QOL, a secondary objective of the study, was evaluated using the European Organisation for Research and Treatment for Cancer (EORTC) Quality of Life Questionnaire (QLQ) C30 and QLQ CR29 questionnaires at baseline, during the final week of radiotherapy and, at six months after radiotherapy. The impact of the treatment arm on QOL scores was evaluated using analysis of covariance after adjusting for the preintervention scores. 94 patients were accrued between October 2014 and March 2020. The trial was terminated early due to futility of the primary outcome, acute gastrointestinal toxicity, at interim analysis. Eighty-six (91%) patients completed the baseline questionnaire and one other timepoint of assessment. Median follow-up was 1.9 years. Overall, both during the final week of radiotherapy and at six months, emotional functioning had improved, but physical, role, and social functionings had declined compared to that at baseline. At baseline, there was no difference in QOL scores between the two arms. During the final week of radiotherapy, the IMRT arm was associated with better adjusted mean physical (p = 0.04) and role functioning (p = 0.01) scores. IMRT is associated with limited QOL benefits compared to 3DCRT in patients undergoing neoadjuvant chemoradiotherapy for locally advanced rectal cancer. • No previous randomised trials have compared the impact of 3DCRT and IMRT on quality of life (QOL) in this setting. • IMRT has limited QOL benefits over 3DCRT in the neoadjuvant setting for locally advanced rectal cancer. • The limited QOL benefit of IMRT may aid clinician decision-making in respect to planning technique. [ABSTRACT FROM AUTHOR]

The aim of the study was to compare the use of 3D-CRT and IMRT in pre-operative long course chemo-radiotherapy for locally advanced rectal cancer. We herein evaluate the impact of the two treatment modalities on quality of life (QOL), a secondary objective of the study. 94 patients with rectal adenocarcinoma were enrolled in a prospective randomized phase II trial across three institutions between 2014 and 2020. Eligible patients had stage T3-4, N(any) or circumferential resection margin at risk with no evidence of metastatic disease. All patients were prescribed 50.4Gy in 28 fractions with concomitant 5-fluorouracil or capecitabine. Patients were randomly assigned (1:1) to 3D-CRT and IMRT planning techniques. QOL was assessed using the EORTC QLQ C30 and QLQ CR29 questionnaires at baseline, during the final week of radiotherapy and at six and twelve months after radiotherapy. A paired sample t test was used to compare differences in QOL from baseline to each follow-up. One-way between-group analyses of covariance (ANCOVA) were conducted to compare the effect of the trial arms on each QOL score. At a median follow-up of 14 months, the trial was terminated early due to failure to establish efficacy in the primary outcome, acute gastrointestinal toxicity. The median age was 59 years and 72/94 (77%) were male. 86/94 (91%) patients completed the baseline and at least one other QOL assessments. QOL data at one year was available in 55/94(58%). At baseline, there was no difference in QOL scores between trial arms. Overall, emotional functioning had improved at six months but physical, cognitive, role and social functioning had declined. At six months, there was a significant improvement in constipation, blood and mucous in stool, bloating, urinary frequency, buttock pain and anxiety scores compared to baseline. There was a significant deterioration in dyspnea, fatigue, nausea/vomiting, taste, hair loss, erectile dysfunction, body image and global health scores from baseline to 6-month follow-up. After adjusting for pre-intervention score, the IMRT arm had better physical functioning (p=0.038) and role functioning (p=0.014) during the final week of radiotherapy compared to the 3DCRT arm. The end of radiotherapy embarrassment score, for those without a stoma, was significantly worse in the IMRT arm (p=0.032). There was no other significant difference in QOL scores between the two arms, at either the final week of radiotherapy or at 6 months, after adjustment for pre-intervention scores. The limitations of the study include its early termination, the potential for type 1 error and the possible influence of other factors on QOL data such as chemotherapy and postoperative complications. There are limited QOL benefits of IMRT compared to 3D-CRT in the neoadjuvant setting for rectal cancer. [ABSTRACT FROM AUTHOR]

Abstract: This paper presents the results of the Phase A study for the solar electric propulsion subsystem selected for the ESA European Student Moon Orbiter spacecraft, performed at QinetiQ under ESA funding. To minimise mass, a so-called “all electric” approach is adopted based around the re-use of a flight-spare GOCE T5 gridded ion engine and the introduction of hollow cathode thrusters (HCTs) for attitude control functions. Three different subsystem architectures are considered and analysed with reference to the mass, cost, risk and level of integration between the HCTs and the T5. The favoured system architecture that best meets the various requirements adopts a shared tank and gas flow controller between the HCTs and the T5, with power being supplied from two dedicated power processing units. The possibility of reducing the propellant requirement by using an engine gimbal mechanism is also presented. The study also demonstrates how an increase in the T5 specific impulse to higher values than used on GOCE does not offer substantial system-level mass savings in this particular case. [Copyright &y& Elsevier]

Abstract: Variable-specific-impulse electric propulsion systems can provide important advantages and cost reductions to any scale of planetary mission. The first part of this paper describes their potential benefits, with special emphasis on mission analysis aspects. The second part identifies the physical limitations of traditional electric propulsion technologies and presents some preliminary development results achieved within the frame of ongoing European activities. [Copyright &y& Elsevier]