ABSTRACT
PURPOSE OF THE RESEARCH: To evaluate nursing practice in Flanders (Belgium) regarding skin care during radiotherapy and the effect of the introduction of an evidence based protocol on daily nursing practice. METHODS AND SAMPLE: Nurses working at radiotherapy departments in Flanders were invited to complete a 58-item questionnaire. The survey was undertaken in 2001 (n=67) and end of 2006 (n=89). Following the survey in 2001 an evidence based skin care protocol was made available for radiotherapy nurses and presented at their respective radiotherapy services. The questionnaire asked to what extend they advised their patients about skin care topics grouped in four sections: prevention, erythema, dry desquamation, moist desquamation. KEY RESULTS: The surveys revealed large varieties in the management of skin reactions although there seems to be less variety and more consensus in the 2006 survey. Regarding preventive advice and the advice in case of erythema, dry desquamation and/or moist desquamation a major improvement was observed in the adoption of key principles such as washing and hydrating the irradiated site and the use of occlusive dressings and the omission of outdated techniques such as talcum powder, Eosin 2% and Gentian violet. CONCLUSIONS: The management of skin reactions does not always correspond with current scientific knowledge. However, the results of this study show that the dissemination and implementation of a skin care protocol enhanced standardization in Flanders, improved adheration to evidence based guidelines and lead to the disappearance of outdated ritualistic practices.
Subject(s)
Clinical Protocols , Oncology Nursing/organization & administration , Patient Education as Topic/organization & administration , Practice Patterns, Nurses'/organization & administration , Radiodermatitis/nursing , Skin Care , Adult , Belgium , Chi-Square Distribution , Clinical Protocols/standards , Evidence-Based Practice/organization & administration , Female , Guideline Adherence/organization & administration , Health Knowledge, Attitudes, Practice , Humans , Male , Nursing Evaluation Research , Nursing Staff, Hospital/education , Nursing Staff, Hospital/organization & administration , Nursing Staff, Hospital/psychology , Practice Guidelines as Topic , Radiodermatitis/etiology , Radiodermatitis/prevention & control , Radiotherapy/adverse effects , Self Care , Skin Care/methods , Skin Care/nursing , Skin Care/standards , Surveys and QuestionnairesABSTRACT
PURPOSE: The aim of this study was to provide estimates of setup and internal margins of patients treated for rectal carcinoma using helical tomotherapy and to assess possible margin adaptations. Using helical tomotherapy, highly conformal dose distributions can be created, and the integrated megavoltage computed tomography (MVCT) modality allows very precise daily patient positioning. In clinical protocols, however, margins originating from traditional setup procedures are still being applied. This work investigates whether this modality can aid in redefining treatment margins. METHODS AND MATERIALS: Ten patients who were treated with tomotherapy underwent MVCT scanning before and after 10 treatments. Using automatic registration the necessary setup margin was investigated by means of bony landmarks. Internal margins were assessed by delineating and describing the mesorectal movement. RESULTS: Based on bony landmarks, movement of patients during treatments was limited to 2.45 mm, 1.99 mm, and 1.09 mm in the lateral, longitudinal, and vertical direction, respectively. Systematic errors were limited to <1 mm. Measured movement of the mesorectal space was -1.6 mm (+/- 4.2 mm) and 0.1 mm (+/- 4.0 mm) for left and right lateral direction. In the antero-posterior direction, mean shifts were -2 mm (+/- 6.8 mm) and -0.4 mm (+/- 3.8 mm). Mean shifts in the cranio-caudal direction were respectively -3.2 mm (+/- 5.6 mm) and -3.2 mm (+/- 6.8 mm). CONCLUSIONS: The use of the integrated MVCT on the tomotherapy system can minimize the setup margin for rectal cancer, and can also be used to adequately describe the internal margin allowing for direct treatment margin adaptation.
Subject(s)
Artifacts , Movement , Radiographic Image Enhancement/methods , Rectal Neoplasms/diagnostic imaging , Rectal Neoplasms/radiotherapy , Tomography, X-Ray Computed/methods , Humans , Radiation Dosage , Reproducibility of Results , Sensitivity and SpecificityABSTRACT
PURPOSE: The aim of the study was to measure the mean duration of treatments and to investigate the occasional events, with extreme influence on treatment time. PATIENTS AND METHODS: Time measurements were performed from the start of patient treatments (n=72) and one year later (n=27) on TomoTherapy. The time interval of the different procedures during treatment was measured. The cause of extra long treatment time was examined. All patients received a MV-CT scan prior to treatment. RESULTS: The mean overall total treatment time per localization ranged from 21.3 to 27.4 min. In 4.1% of the total population extreme long time measurements have been observed, interruptions due to equipment malfunction being the main cause (57.5%). Comparison between time measurements performed after clinical implementation and time measurements performed one year later to examine the learning curve, showed no differences. CONCLUSION: Treating a patient on TomoTherapy takes approximately 25 min, yielding 19 patients to be treated within 8 h. However, occasional treatment interruptions and variations in time of irradiation have a certain impact on daily patient scheduling for treatment, and influences the workload from day-to-day.
