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We started using intraoperative electron radiation therapy (IOERT) as a boost during breast conserving surgery in June 2012. The risk assessment was carried out before starting clinical trials and was integrated with a predictive matrix risk analysis (FMECA). Even after the introduction of corrective actions, the highest score was attributed to the misalignment of the internal shield which was used to protect the underlying normal tissues. In November 2014, we began using the new HIOB protocol (IOERT 11,1 Gy, WBERT 2,7 Gy in 15 fractions) and at the same time Intraoperative ultrasonography (IOUS) was introduced based on the recommendation of HIOB protocol in order to accurately measure depth of target and accordingly selection of the proper electron energy. The aim of this study is to evaluate the role of intraoperative ultrasonography in reducing risk and improving quality of breast IOERT

The increasing use of daily CBCT in radiotherapy has raised concerns about the additional dose delivered to the patient, and it can also become a concern issue for those patients with cardiovascular implantable electronic devices (CIEDs) (Pacemaker [PM] and Implantable Cardioverter Defibrillator [ICD]). Although guidelines highly recommend that the cumulative dose received by CIEDs should be kept as low as possible, and a safe threshold based on patient risk classification needs to be respected, this additional imaging dose is not usually considered. Four centers with different dosimetry systems and different CBCT imaging protocols participated in this multicenter study to investigate the imaging dose to the CIEDs from Elekta XVI and Varian OBI kV-CBCT systems. It was found that although imaging doses received by CIEDs outside the CBCT field are negligible, special attention should be paid to this value when CIEDs are inside the field because the daily use of CBCT can sometimes contribute considerably to the total dose received by a CIED.

Intraoperative electron radiation therapy (IOERT) cannot usually benefit, as conventional external radiotherapy, from software systems of treatment planning based on computed tomography and from common dose verify procedures. For this reason, in vivo film dosimetry (IVFD) proves to be an effective methodology to evaluate the actual radiation dose delivered to the target. A practical method for IVFD during breast IOERT was carried out to improve information on the dose actually delivered to the tumor target and on the alignment of the shielding disk with respect to the electron beam. Two EBT3 GAFCHROMIC films have been positioned on the two sides of the shielding disk in order to obtain the dose maps at the target and beyond the disk. Moreover the postprocessing analysis of the dose distribution measured on the films provides a quantitative estimate of the misalignment between the collimator and the disk. EBT3 radiochromic films have been demonstrated to be suitable dosimeters for IVD due to their linear dose‐optical density response in a narrow range around the prescribed dose, as well as their capability to be fixed to the shielding disk without giving any distortion in the dose distribution. Off‐line analysis of the radiochromic film allowed absolute dose measurements and this is indeed a very important verification of the correct exposure to the target organ, as well as an estimate of the dose to the healthy tissue underlying the shielding. These dose maps allow surgeons and radiation oncologists to take advantage of qualitative and quantitative feedback for setting more accurate treatment strategies and further optimized procedures. The proper alignment using elastic bands has improved the absolute dose accuracy and the collimator disk alignment by more than 50%. PACS number: 87.55.kh

Introduction The Abdus Salam International Centre for Theoretical Physics (ICTP) and the Trieste University have initiated in 2014 a Master of Advanced Studies in Medical Physics a two-years training programme in Medical Physics. The programme is designated to provide young promising graduates in physics, mainly from developing countries, with a post-graduated theoretical and clinical training suitable to be recognised as Clinical Medical Physicist in their countries. Presently, the 3 cycles of the programme has seen 49 participants from 33 Countries: Africa (19), Asia (11), Central and South America (14), and Europe (5), selected from more than 400 applicants per year. Scholarships are awarded to candidates from developing countries with support of the IAEA, TWAS, KFAS, IOMP, EFOMP and ICTP. Material and methods The programme is developed following the recommendations of IOMP and IAEA for education and clinical training. In the first year 332 lectures and 228 h of exercises are devoted to all main fields of medical physics. The second year is spent in one of the 12 medical physics department of the hospitals’ network for the clinical training in: radiation oncology or diagnostic and nuclear medicine, on a programme developed adapting the IAEA (TCS37, TCS47 and TCS50) and AFRA guidelines. Conclusions IOMP, EFOMP and IAEA are seeing this initiative as an answer to the growing demand of Medical Physicists in developing Countries, representing an important European contribution to the development of medical physics in the developing world.