A B S T R A C TBackground and purpose: Inter-institutional studies highlighted correlation between consistent radiotherapy quality and improved overall patient survival. In treatment planning automation has the potential to address differences due to user-experience and training, promoting standardisation. The aim of this study was to evaluate implementation and clinical effect of a multicentre collaboratively-developed automated planning model for Intensity-Modulated Radiation Therapy/ Volumetric-Modulated Arc Therapy of prostate. The model was built using a variety of public institutions' clinical plans, incorporating different contouring and dose protocols, aiming at minimising their variation. Methods and materials: A model using 110 clinically approved and treated prostate plans provided by different radiotherapy centres was built with RapidPlan (RP), for use on intact and post-prostatectomy prostate cases. The model was validated, distributed and introduced into clinical practice in all institutions. To investigate its impact a total of 126 patients, originally manually inverse planned (OP), were replanned using RP without additional planner manual intervention. Target and organat-risk (OAR) metrics were statistically compared between original and automated plans. Results: For all centres combined and individually, RP provided plans comparable or superior to OP for all dose metrics. Statistically significant reductions with RP were found in bladder (V40Gy) and rectal (V50Gy) low doses (within 2.3% and 3.4% for combined and 4% and 10% individually). No clinically significant changes were seen for the PTV, independently of seminal vesicle inclusion. Conclusion: This project showed it is feasible to develop, share and implement RP models created with plans from different institutions treated with a variety of techniques and dose protocols, with the potential of improving treatment planning results and/or efficiency despite the original variability.

CAM use was prevalent amongst cancer patients undergoing radiotherapy, but frequently not discussed with the treating radiation oncologist. Considering the high prevalence of CAM, further resources could be justifiably directed at providing this service for cancer patients to foster a more holistic approach to their care.

Purpose: It is known that the volume of the bladder can influence the position of the prostate or prostatic bed and the amount of small bowel in external beam radiotherapy treatment for prostate cancer. Therefore reducing the variation of the bladder volume between planning and treatment, should improve the accuracy of treatment. Patients at our radiotherapy centre are instructed to have a comfortably full bladder for treatment. A hand‐held BladderScan® (Diagnostic Ultrasound Europe B.V, IJsselstein, Netherlands) three‐dimensional (3D) ultrasound device was tested for correlation between volumes measured using the BladderScan® and volumes contoured using computed tomography (CT) data. The device was used to assess if patients can judge the comfortably full state of their bladder. In addition it was investigated whether the residual volume of the bladder changed over the course of radiotherapy. Methods: For 11 radical prostate patients measurements of bladder volume using the BladderScan® were taken at CT planning and at each treatment of the full bladder volume prior to the procedure and then with an empty bladder post procedure. Results: We found that there is a good correlation (r = 0.85) between the measured bladder volume and a contoured volume, validating the use of the BladderScan®. Patients could judge the comfortably full state of their bladder at 76.5% of fractions. Over the course of radiotherapy there was equal distribution of positive and negative trends of residual bladder volumes. Conclusion: We conclude that the BladderScan® is a reliable device for assessing bladder volume, and patients can correctly judge their comfortably full bladder in most cases.

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The current study using 4D-CT has shown that the derived MIP is a good surrogate for the evaluation of three-dimensional kidney displacement, and that the volume of the AS is not largely different from the average volume for individual phases. The 4D-CT is useful for the creation of individual patient internal target volume or planning organ at risk volume when kidney motion impacts on radiotherapy planning.