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Crowther K, Carey N, McFadden S, Stenner K, Hughes C. Therapeutic radiographer prescribing practices in the United Kingdom: Questionnaire survey. Radiography (Lond) 2024; 30:964-970. [PMID: 38657390 DOI: 10.1016/j.radi.2024.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 03/12/2024] [Accepted: 04/10/2024] [Indexed: 04/26/2024]
Abstract
INTRODUCTION Non-medical professionals in the United Kingdom (UK) have been granted prescribing rights to improve patient care quality and cost-effectiveness. There is limited evidence on how therapeutic radiographer prescribers have impacted medicine management or patient services. METHODS An online survey was conducted amongst non-medical prescribing therapeutic radiographers in the UK between 2019 and 2022. The study teams initially analysed the individual data sets, subsequently combined, and secondary analysis was performed to provide a UK perspective, to understand the services provided and identify areas for improvement. Data was analysed using descriptive statistics from Microsoft Excel® and SPSS®. RESULTS 74 non-medical prescribing therapeutic radiographers who were predominantly over 40 years old and in full-time work participated. The main job categories were consultant radiographers (n = 23, 31.1%) and advanced practice practitioners (n = 18, 24.3%). Many use their prescribing qualifications (87.5%, n = 62), issuing a mean of 15 independent and seven items by supplementary and prescribing per week. Most received assessment and diagnostic skills training before prescribing courses (91.6%, n = 67). Respondents prescribed from a median of six areas, with the highest being in GI (82%), skin (68%), infections (58%), urinary tract disorders (55%) and ear, nose, and oropharynx conditions (54%). CONCLUSION This study presents the first report on therapeutic radiographers prescribing in the UK, offering insights into current practices and highlighting the success of non-medical prescribing. Therapeutic radiographers' roles continue to expand into advanced practice and medicine-prescribing responsibilities, contributing to holistic and patient-centred care. IMPLICATIONS FOR PRACTICE The results are relevant for nations grappling with oncology workforce shortages and contemplating similar roles for therapeutic radiographers. The study can be a valuable resource for policymakers and healthcare organisations worldwide.
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Affiliation(s)
- K Crowther
- School Health Sciences, Institute of Nursing and Health Research, Ulster University, Belfast, York Street, Belfast, Northern Ireland, UK; Accuray Incorporated, 1240 Deming Way, Madison, WI, USA.
| | - N Carey
- Centre for Rural Health Sciences, University of the Highlands and Islands, 12B Ness Walk, Inverness, Scotland, UK
| | - S McFadden
- School Health Sciences, Institute of Nursing and Health Research, Ulster University, Belfast, York Street, Belfast, Northern Ireland, UK
| | - K Stenner
- School of Health Sciences, University of Surrey, 30 Priestley Road, Surrey Research Park, Guildford, England, UK
| | - C Hughes
- School Health Sciences, Institute of Nursing and Health Research, Ulster University, Belfast, York Street, Belfast, Northern Ireland, UK
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Ellis R, Cole AJ, O'Hare J, Whitten G, Crowther K, Harrison C. Coincidental splenic irradiation and risk of functional hyposplenism in oesophageal cancer treatment. J Med Imaging Radiat Oncol 2021; 65:925-930. [PMID: 34405578 DOI: 10.1111/1754-9485.13310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 07/31/2021] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Definitive chemoradiotherapy (dCRT) and radical radiotherapy are central to the management of distal oesophageal carcinoma. This study sought to establish whether the spleen receives a significant incidental radiation dose when treating distal oesophageal carcinoma with the standardised dCRT or radical radiotherapy doses. METHODS In this single-centre retrospective study, all patients (n = 34) with distal oesophageal cancer, treated with either dCRT or radical radiotherapy over an 18-month period using a volumetric modulated arc therapy (VMAT) planning technique, were included. The median age was 74 years old: 56% were male; 50% (n = 17) had adenocarcinoma and 41% (n = 14) had squamous carcinoma. The majority (79%) received dCRT with a prescribed dose of 50 Gy in 25 fractions while the other 21% of patients were treated with radical radiotherapy alone (55 Gy in 20 fractions). The spleen was retrospectively contoured by one physician, and the V10 Gy and mean splenic dose (MSD) were calculated using Eclipse planning software. RESULTS The median MSD was 14.4 Gy with a range of 0.75-28.3 Gy. The median V10 Gy was 62.7%. Of the cohort, 67.6% received an MSD of more than 10 Gy. CONCLUSIONS Two-thirds of the patients received a dose of more than the 10 Gy. A review of the literature suggests that higher splenic radiation doses may increase the long-term risk of infection and impact on other outcomes. This study provides important evidence that the spleen receives a significant dose of radiation when treating distal oesophageal cancer and should be considered as an organ at risk.
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Affiliation(s)
| | - Aidan J Cole
- Northern Ireland Cancer Centre, Belfast, UK.,Centre for Medical Education, Queen's University Belfast, Belfast, UK
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Crowther K. Evaluation of patient experience and satisfaction during gastrointestinal radiotherapy treatment. Radiography (Lond) 2020. [DOI: 10.1016/j.radi.2019.11.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Osman SOS, Russell E, King RB, Crowther K, Jain S, McGrath C, Hounsell AR, Prise KM, McGarry CK. Fiducial markers visibility and artefacts in prostate cancer radiotherapy multi-modality imaging. Radiat Oncol 2019; 14:237. [PMID: 31878967 PMCID: PMC6933910 DOI: 10.1186/s13014-019-1447-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 12/15/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND In this study, a novel pelvic phantom was developed and used to assess the visibility and presence of artefacts from different types of commercial fiducial markers (FMs) on multi-modality imaging relevant to prostate cancer. METHODS AND MATERIALS The phantom was designed with 3D printed hollow cubes in the centre. These cubes were filled with gel to mimic the prostate gland and two parallel PVC rods were used to mimic bones in the pelvic region. Each cube was filled with gelatine and three unique FMs were positioned with a clinically-relevant spatial distribution. The FMs investigated were; Gold Marker (GM) CIVCO, GM RiverPoint, GM Gold Anchor (GA) line and ball shape, and polymer marker (PM) from CIVCO. The phantom was scanned using several imaging modalities typically used to image prostate cancer patients; MRI, CT, CBCT, planar kV-pair, ExacTrac, 6MV, 2.5MV and integrated EPID imaging. The visibility of the markers and any observed artefacts in the phantom were compared to in-vivo scans of prostate cancer patients with FMs. RESULTS All GMs were visible in volumetric scans, however, they also had the most visible artefacts on CT and CBCT scans, with the magnitude of artefacts increasing with FM size. PM FMs had the least visible artefacts in volumetric scans but they were not visible on portal images and had poor visibility on lateral kV images. The smallest diameter GMs (GA) were the most difficult GMs to identify on lateral kV images. CONCLUSION The choice between different FMs is also dependent on the adopted IGRT strategy. PM was found to be superior to investigated gold markers in the most commonly used modalities in the management of prostate cancer; CT, CBCT and MRI imaging.
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Affiliation(s)
- Sarah O. S. Osman
- Centre of Cancer Research and Cell Biology, Queen’s University Belfast, Belfast, Northern Ireland BT7 1NN UK
- Radiotherapy Physics, Northern Ireland Cancer Centre, Belfast Health and Social Care Trust, Belfast, UK
| | - Emily Russell
- Centre of Cancer Research and Cell Biology, Queen’s University Belfast, Belfast, Northern Ireland BT7 1NN UK
| | - Raymond B. King
- Radiotherapy Physics, Northern Ireland Cancer Centre, Belfast Health and Social Care Trust, Belfast, UK
| | - Karen Crowther
- Radiotherapy Department, Northern Ireland Cancer Centre, Belfast Health and Social Care Trust, Belfast, UK
| | - Suneil Jain
- Centre of Cancer Research and Cell Biology, Queen’s University Belfast, Belfast, Northern Ireland BT7 1NN UK
- Clinical Oncology, Northern Ireland Cancer Centre, Belfast Health and Social Care Trust, Belfast, UK
| | - Cormac McGrath
- Radiological Sciences and Imaging, Belfast Health and Social Care Trust, Forster Green Hospital, Belfast, UK
| | - Alan R. Hounsell
- Centre of Cancer Research and Cell Biology, Queen’s University Belfast, Belfast, Northern Ireland BT7 1NN UK
- Radiotherapy Physics, Northern Ireland Cancer Centre, Belfast Health and Social Care Trust, Belfast, UK
| | - Kevin M. Prise
- Centre of Cancer Research and Cell Biology, Queen’s University Belfast, Belfast, Northern Ireland BT7 1NN UK
| | - Conor K. McGarry
- Centre of Cancer Research and Cell Biology, Queen’s University Belfast, Belfast, Northern Ireland BT7 1NN UK
- Radiotherapy Physics, Northern Ireland Cancer Centre, Belfast Health and Social Care Trust, Belfast, UK
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Farrell R, Jain S, Shiels P, Workman G, Crowther K, Mitchell D. EP-2155 Optimising HDR Prostate Implant, Planning and delivery. A new centre experience. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)32575-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Crowther K, Osman S, O'Hare S, Gray S, Holland D, Vennard H, Hanna G. OC-0098 Gated vs coached DIBH treatment in left sided breast cancer radiotherapy: a single centre study. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)30518-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Crowther K, Cole A, Shiels P, Jain S, Shepherd P, Mitchell D. A pilot study of patient reported outcomes evaluating treatment related symptoms and quality of life for men receiving high dose rate brachytherapy combined with hypo-fractionated radiotherapy or hypo-fractionated radiotherapy alone for the treatment of localised prostate cancer. Tech Innov Patient Support Radiat Oncol 2019; 9:18-25. [PMID: 32095591 PMCID: PMC7033792 DOI: 10.1016/j.tipsro.2019.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 11/26/2018] [Accepted: 01/17/2019] [Indexed: 12/01/2022] Open
Abstract
PROMs have an important role to play in clinical practice. The radiographer-led collection of multiple PROMs is feasible. Monotherapy Group reported higher levels of bowel toxicity than Combination Group. RTOG scale was not of sufficient sensitivity and under-reported symptoms. A good QoL was maintained throughout treatment for both treatment groups.
Patient Reported Outcome Measures (PROMS) are useful metrics in evidence-based clinical care and translational research. Recording treatment-related symptoms and Quality of Life (QoL) can provide information in counselling patients to aid decision-making. This prospective study tested the feasibility of radiographer-led collection of multiple validated PROMS from Prostate Cancer (PCa) patients comparing High Dose Rate Brachytherapy combined with hypo-fractionated external beam radiotherapy (hEBRT) and hEBRT alone. From June to August 2017, 20 men with localised PCa (T1-T3aN0M0) consented to participate in the study. Ten patients received combination treatment (37.5 Gray/15 fractions followed by a 15 Gray implant), and ten patients received monotherapy (60 Gray/20 fractions). PROMS were collected at four time-points (1) at baseline, (2) final fraction of hEBRT, (3) 8 weeks after commencing radiotherapy and (4) 12 weeks after commencing radiotherapy. The PROMS used were EPIC-26, IPSS, IIEFF-5 and SF-12. The difference between the two groups were tested using Mann-Whitney U test and Wilcoxon Signed-Rank Test. All participants completed all PROMS (100% response-rate). The Monotherapy group reported a higher incidence of bowel symptoms compared to the combination group and at Week 12, EPIC-26 bowel summary score demonstrated a statistically significant difference (p = 0.005). The prevalence of erectile dysfunction increased within both groups. Maintenance of QoL was reported throughout treatment. This small study demonstrated feasibility of radiographer-led PROMS collection by 100% completion rate. Streamlining of these tools into integrated technology applications and real time PROMS measurement has the ability to benefit patients and guide clinicians in adapting therapies based on individual need.
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Affiliation(s)
- Karen Crowther
- Radiotherapy Department, Cancer Centre, Belfast City Hospital, Belfast Health and Social Care Trust, Lisburn Road, Belfast, United Kingdom
| | - Aidan Cole
- Radiotherapy Department, Cancer Centre, Belfast City Hospital, Belfast Health and Social Care Trust, Lisburn Road, Belfast, United Kingdom.,Centre for Cancer Research and Cell Biology, Queen's University of Belfast, Lisburn Road, Belfast, United Kingdom
| | - Pat Shiels
- Radiotherapy Department, Cancer Centre, Belfast City Hospital, Belfast Health and Social Care Trust, Lisburn Road, Belfast, United Kingdom
| | - Suneil Jain
- Radiotherapy Department, Cancer Centre, Belfast City Hospital, Belfast Health and Social Care Trust, Lisburn Road, Belfast, United Kingdom.,Centre for Cancer Research and Cell Biology, Queen's University of Belfast, Lisburn Road, Belfast, United Kingdom
| | - Paul Shepherd
- Ulster University, Therapeutic Radiography - School of Health Sciences, Belfast, United Kingdom
| | - Darren Mitchell
- Radiotherapy Department, Cancer Centre, Belfast City Hospital, Belfast Health and Social Care Trust, Lisburn Road, Belfast, United Kingdom
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O'Neill A, King R, Crowther K, Osman S, Jain S, Hounsell A, O'Sullivan J. PV-0365: CASPIR Trial: Calculi as an alternative to fiducial markers for IGRT in localised prostate cancer. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)30675-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Hetherington S, Crowther K, Jain S, Mitchell D, O'Sullivan J, Shum L, Gilleece T. EP-2397: Therapeutic Radiographer follow up for prostate cancer patients. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)32705-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Crowther K. EP-1843: An audit evaluating the frequency of patient re-preparation after CBCT analysis in prostate IMRT. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)32278-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Osman SOS, Horn S, Brady D, McMahon SJ, Yoosuf ABM, Mitchell D, Crowther K, Lyons CA, Hounsell AR, Prise KM, McGarry CK, Jain S, O'Sullivan JM. Prostate cancer treated with brachytherapy; an exploratory study of dose-dependent biomarkers and quality of life. Radiat Oncol 2017; 12:53. [PMID: 28288658 PMCID: PMC5348795 DOI: 10.1186/s13014-017-0792-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 02/26/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Low-dose-rate permanent prostate brachytherapy (PPB) is an attractive treatment option for patients with localised prostate cancer with excellent outcomes. As standard CT-based post-implant dosimetry often correlates poorly with late treatment-related toxicity, this exploratory (proof of concept) study was conducted to investigate correlations between radiation - induced DNA damage biomarker levels, and acute and late bowel, urinary, and sexual toxicity. METHODS Twelve patients treated with 125I PPB monotherapy (145Gy) for prostate cancer were included in this prospective study. Post-implant CT based dosimetry assessed the minimum dose encompassing 90% (D90%) of the whole prostate volume (global), sub-regions of the prostate (12 sectors) and the near maximum doses (D0.1cc, D2cc) for the rectum and bladder. Six blood samples were collected from each patient; pre-treatment, 1 h (h), 4 h, 24 h post-implant, at 4 weeks (w) and at 3 months (m). DNA double strand breaks were investigated by staining the blood samples with immunofluorescence antibodies to γH2AX and 53BP1 proteins (γH2AX/53BP1). Patient self-scored quality of life from the Expanded Prostate Cancer Index Composite (EPIC) were obtained at baseline, 1 m, 3 m, 6 m, 9 m, 1 year (y), 2y and 3y post-treatment. Spearman's correlation coefficients were used to evaluate correlations between temporal changes in γH2AX/53BP1, dose and toxicity. RESULTS The minimum follow up was 2 years. Population mean prostate D90% was 144.6 ± 12.1 Gy and rectal near maximum dose D0.1cc = 153.0 ± 30.8 Gy and D2cc = 62.7 ± 12.1 Gy and for the bladder D0.1cc = 123.1 ± 27.0 Gy and D2cc = 70.9 ± 11.9 Gy. Changes in EPIC scores from baseline showed high positive correlation between acute toxicity and late toxicity for both urinary and bowel symptoms. Increased production of γH2AX/53BP1 at 24 h relative to baseline positively correlated with late bowel symptoms. Overall, no correlations were observed between dose metrics (prostate global or sector doses) and γH2AX/53BP1 foci counts. CONCLUSIONS Our results show that a prompt increase in γH2AX/53BP1foci at 24 h post-implant relative to baseline may be a useful measure to assess elevated risk of late RT - related toxicities for PPB patients. A subsequent investigation recruiting a larger cohort of patients is warranted to verify our findings.
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Affiliation(s)
- Sarah O S Osman
- Centre of Cancer Research and Cell Biology, Queen's University Belfast, BT7 1NN, Belfast, UK.
| | - Simon Horn
- Centre of Cancer Research and Cell Biology, Queen's University Belfast, BT7 1NN, Belfast, UK
| | - Darren Brady
- Centre of Cancer Research and Cell Biology, Queen's University Belfast, BT7 1NN, Belfast, UK
| | - Stephen J McMahon
- Centre of Cancer Research and Cell Biology, Queen's University Belfast, BT7 1NN, Belfast, UK
| | - Ahamed B Mohamed Yoosuf
- Radiotherapy Physics, Northern Ireland Cancer Centre, Belfast Health and Social Care Trust, Belfast, UK
| | - Darren Mitchell
- Clinical Oncology, Northern Ireland Cancer Centre, Belfast Health and Social Care Trust, Belfast, UK
| | - Karen Crowther
- Radiotherapy Physics, Northern Ireland Cancer Centre, Belfast Health and Social Care Trust, Belfast, UK
| | - Ciara A Lyons
- Centre of Cancer Research and Cell Biology, Queen's University Belfast, BT7 1NN, Belfast, UK
| | - Alan R Hounsell
- Centre of Cancer Research and Cell Biology, Queen's University Belfast, BT7 1NN, Belfast, UK.,Radiotherapy Physics, Northern Ireland Cancer Centre, Belfast Health and Social Care Trust, Belfast, UK
| | - Kevin M Prise
- Centre of Cancer Research and Cell Biology, Queen's University Belfast, BT7 1NN, Belfast, UK
| | - Conor K McGarry
- Centre of Cancer Research and Cell Biology, Queen's University Belfast, BT7 1NN, Belfast, UK.,Radiotherapy Physics, Northern Ireland Cancer Centre, Belfast Health and Social Care Trust, Belfast, UK
| | - Suneil Jain
- Centre of Cancer Research and Cell Biology, Queen's University Belfast, BT7 1NN, Belfast, UK.,Clinical Oncology, Northern Ireland Cancer Centre, Belfast Health and Social Care Trust, Belfast, UK
| | - Joe M O'Sullivan
- Centre of Cancer Research and Cell Biology, Queen's University Belfast, BT7 1NN, Belfast, UK.,Clinical Oncology, Northern Ireland Cancer Centre, Belfast Health and Social Care Trust, Belfast, UK
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