Purpose:The purpose of this case study is to discuss factors that have an influence on the process of role development in radiotherapy breast planning.Key themes:This article describes the process of development as experienced by the author and discusses factors that hindered the process of role development. These factors include development of a career plan, professional issues, resources, organisational structures, support from consultants, managers, multi-disciplinary, and professional colleagues and peer resistance.Conclusion:The author makes recommendations that may contribute to improving the role development strategy in the profession and aid successful implementation of advanced practitioner and consultant roles for those radiographers who aspire to the consultant radiographer role in future. The article concludes that there is a need to identify, standardise and coordinate role development for therapy radiographers nationally to increase the appointment of more consultant radiographers.
Objectives: Field-based planning for regional nodal breast radiotherapy (RT) used to be standard practice. This study evaluated a field-based posterior axillary boost (PAB) and two forward-planned intensity-modulated radiotherapy (IMRT) techniques, aiming to replace the first. Methods: Supraclavicular and axillary nodes, humeral head, brachial plexus, thyroid, and oesophagus were retrospectively delineated on 12 computed tomography scans. Three plans, prescribed to 40.05 Gy, were produced for each patient. Breast plans consisted of field-in-field IMRT tangential fields in all three techniques. Nodal plans consisted of three forward-planned techniques: field-based PAB (anterior and posterior boost beam), simple IMRT 1 (anterior and posterior beam with limited segments), and a more advanced IMRT two technique (anterior and fully modulated posterior beam). Results: The nodal V90% was similar between IMRT 1: mean 99.5% (SD 1.0) and IMRT 2: 99.4% (SD 0.5). Both demonstrated significantly improved results (p = 0.0001 and 0.005, respectively) compared to the field-based PAB technique. IMRT two lung V12Gy and humeral head V10Gy were significantly lower (p = 0.002, 0.0001, respectively) than the field-based PAB technique. IMRT one exhibited significantly lower brachial plexus Dmax and humeral head V5, 10, and 15Gy doses (p = 0.007, 0.013, 0.007, and 0.007, respectively) compared to the field-based PAB technique. The oesophagus and thyroid dose difference between methods was insignificant. Conclusions: Both IMRT techniques achieved the dose coverage requirements and reduced normal tissue exposure, decreasing the risk of radiation side-effects. Despite the increased cost of IMRT, compared to non-IMRT techniques 1, both IMRT techniques are suitable for supraclavicular and axillary nodal RT. Advances in knowledge: Forward-planned IMRT already resulted in significant dose reduction to organs at risk and improved planning target volume coverage. This new, simplified forward-planned IMRT one technique has not been published in this context and is easy to implement in routine clinical practice.
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