Acute skin toxicity occurs in the majority of the patients undergoing radical radiotherapy. While a variety of topical agents and dressing are used to ameliorate side effects, there is minimal evidence to support their use. The aims of this study were to systematically review evidence on acute skin toxicity management and to assess the current practices in ANZ. A systematic review of the literature was conducted on studies published between 1980 and 2008. A meta-analysis was performed on articles on clinical trials reporting grade II or greater toxicity. Analyses were divided into breast (the most common site) and other sites. A survey of Radiation Oncology departments across ANZ was conducted to identify patterns of practices and compare these with the published evidence. Twenty-nine articles were reviewed. Only seven articles demonstrated statistically significant results for management of side-effects. These were for topical corticosteroids, hyaluronic acid, sucralfate, calendula, Cavilon cream (3M, St Paul, Minnesota, USA) and silver leaf dressing. Meta-analysis demonstrated statistical significance for the prophylactic use of topical agents in the management acute toxicity. The survey of departments had a low response rate but demonstrated variation in skin care practices across ANZ. A considerable number of these practices were based only on anecdotal evidence. Lack of evidence in the literature for the care of radiation skin reactions was associated with variation in practice. Only a limited number of studies have demonstrated a significant benefit of specific topical agents. There is a need for objective and prospective recording of skin toxicity to collect meaningful comparative data on which to base recommendations for practice.

The increased utilisation of magnetic resonance imaging (MRI) in radiation therapy (RT) has led to the implementation of MRI simulators for RT treatment planning and influenced the development of MRI‐guided treatment systems. There is extensive literature on the advantages of MRI for tumour volume and organ‐at‐risk delineation compared to computed tomography. MRI provides both anatomical and functional information for RT treatment planning (RTP) as well as quantitative information to assess tumour response for adaptive treatment. Despite many advantages of MRI in RT, introducing an MRI simulator into a RT department is a challenge. Collaboration between radiographers and radiation therapists is paramount in making the best use of this technology. The cross‐disciplinary training of radiographers and radiation therapists alike is an area rarely discussed; however, it is becoming an important requirement due to detailed imaging needs for advanced RT treatment techniques and with the emergence of hybrid treatment systems. This article will discuss the initial experiences of a radiation oncology department in implementing a dedicated MRI simulator for RTP, with a focus on the training required for both radiographer and RT staff. It will also address the future of MRI in RT and the implementation of MRI‐guided treatment systems, such as MRI‐Linacs, and the role of both radiation therapists and radiographers in this technology.

This work will be of interest to the increasing number of centres wanting to incorporate quantitative DWI in a clinical setting.

Delineation of HR-CTV for cervical cancer brachytherapy was consistent amongst observers, suggesting similar interpretation of GEC-ESTRO guidelines. Despite the good concordance, there was dosimetric variation noted, which could be clinically significant.

IntroductionA magnetic resonance (MR) scanner for radiotherapy treatment simulation was commissioned in our department in June 2013. Practical set up and MR image quality trade‐offs using a variety of patient positions and immobilisation devices routinely used in the treatment planning of rectal cancer patients were considered. The study also aimed to investigate the MR compatibility of the device materials with a focus on temperature changes during routine clinical examinations.MethodsTen volunteers were scanned: (1) Prone on a Civco Contoura Bellyboard (BBB), (2) Prone on a Civco MR Series Bellyboard (WBB), (3) Prone with no bellyboard and (4) Supine. All scans were performed with a T 2 weighted (T 2‐w) turbo spin echo (TSE) sequence. Images were scored by five assessors for: (1) ease of identifying specific organs, (2) overall image quality and (3) signal to noise ratio (SNR). Temperature changes were measured for each volunteer in each position.ResultsBoth expert scores and SNR analysis demonstrated that images obtained in the supine position allowed for easier and clearer delineation of the organs. Image factors such as artefacts and noise, along with the overall image quality, also performed better in the supine position. The carbon fibre bellyboard did not demonstrate significant heating during scanning with the T 2‐w TSE transverse sequence.ConclusionsA supine position was determined to be superior to the other positions in a majority of comparisons. The volunteers did not experience any increased temperature changes during scanning on the bellyboard in comparison to the other positions.