We, ourselves and us: Tensions of identity, intersubjectivity and positionality stemming from the people and dancefloors project.

Grounded in intersubjective participatory action research, the people and dancefloors project has sought to produce a space for the co-creation of knowledge about dancefloors and drug taking, building a platform for developing insights from the positionality of current drug users. Through film, it provides hermeneutic insight while legitimising their voices. In this paper, we share some reflections as researchers/users/activists arising from our involvement in the project. To begin with, we reflect on the motivations for the project, and the epistemic suppositions that animated it. This is followed by conversational style interviews where we re-evaluate our position in light of the project, with a particular focus on the tensions that drug use introduces between professional, personal and political domains in our lives. These reflections are useful to people who use drugs and hold privilege by nature of their social and cultural position. While questioning the silencing of personal experiences in relation to drug use, we also react to some of the traditional tendencies of academia, including institutionalised individualism, which isolates researchers and discourages them from finding political collectivity, and the subjectivist/objectivist dichotomy, which supports a tendency to objectify research participants while removing the self from the equation. Despite the challenges that arise from disentangling our multiple experiences and identities, our intersubjective dialogue inspires deeper learning about ourselves and each other, encouraging us towards a more openly political stance.

A low-dose ipsilateral lung restriction improves 3-d conformal planning for partial breast radiation therapy.

In trials of 3D conformal external beam partial breast radiotherapy (PBRT), the dosimetrist must balance the priorities of achieving high conformity to the target versus minimizing low-dose exposure to the normal structures. This study highlights the caveat that in the absence of a low-dose lung restriction, the use of relatively en-face fields may meet trial-defined requirements but expose the ipsilateral lung to unnecessary low-dose radiation. Adding a low-dose restriction that ≤ 20% of the ipsilateral lung should receive 10% of the prescribed dose resulted in successful plans in 88% of cases. This low-dose lung limit should be used in PBRT planning.

Respiratory Gating: Using Deep Inspiration Breath Hold Radiation Therapy to Treat Left Breast Cancer.

Radiation therapy with respiratory gating has typically been used in the treatment of lung tumours. This technique offers clinical advantages when applied to other sites as well. This is a case report of a 47-year-old woman who presented with a localized recurrent breast cancer in the left 6th intercostal space and declined a chest wall resection. Standard radiation therapy carried a significant risk of cardiac toxicity. A respiratory gated, deep inspiration breath-hold technique (DIBH) was developed that significantly reduced the dose to her heart and ipsilateral lung while delivering a curative dose (70 Gy) to the recurrent tumour. Treatment accuracy, setup, reproducibility, and daily treatment times were measured. DIBH was tolerable, reproducible, and, after the first week, could be delivered within a 15-minute treatment slot. Toxicity was minimal.

Consistency in seroma contouring for partial breast radiotherapy: impact of guidelines.

PURPOSE: Inconsistencies in contouring target structures can undermine the precision of conformal radiation therapy (RT) planning and compromise the validity of clinical trial results. This study evaluated the impact of guidelines on consistency in target volume contouring for partial breast RT planning. METHODS AND MATERIALS: Guidelines for target volume definition for partial breast radiation therapy (PBRT) planning were developed by members of the steering committee for a pilot trial of PBRT using conformal external beam planning. In phase 1, delineation of the breast seroma in 5 early-stage breast cancer patients was independently performed by a "trained" cohort of four radiation oncologists who were provided with these guidelines and an "untrained" cohort of four radiation oncologists who contoured without guidelines. Using automated planning software, the seroma target volume (STV) was expanded into a clinical target volume (CTV) and planning target volume (PTV) for each oncologist. Means and standard deviations were calculated, and two-tailed t tests were used to assess differences between the "trained" and "untrained" cohorts. In phase 2, all eight radiation oncologists were provided with the same contouring guidelines, and were asked to delineate the seroma in five new cases. Data were again analyzed to evaluate consistency between the two cohorts. RESULTS: The "untrained" cohort contoured larger seroma volumes and had larger CTVs and PTVs compared with the "trained" cohort in three of five cases. When seroma contouring was performed after review of contouring guidelines, the differences in the STVs, CTVs, and PTVs were no longer statistically significant. CONCLUSION: Guidelines can improve consistency among radiation oncologists performing target volume delineation for PBRT planning.