Comparison of CT-volumed supraclavicular fossa radiotherapy planning and conventional simulator-planned defined by bony landmarks for early breast cancer.

AIM: A comparison of techniques, CT planning of the supraclavicular fossa and field based simulation. We highlight CT planned SCF radiotherapy which would be useful for a centre introducing the technique. BACKGROUND: Development of radiotherapy technique includes a move from field-based simulation to CT planning. MATERIALS AND METHODS: We conducted a retrospective review of the first 50 patients receiving radiotherapy according to the 3D CT planning protocol. Production of the previous field based technique, by virtual simulation methods on the same 50 patient CT data sets allowed both techniques to be compared for beam energy, field size, planning target volume (PTV) minimum and maximum, mean doses, depth dose normalisation, V40% lung volume and brachial plexus. RESULTS: 88% CT-volumed plans received mean dose within ICRU recommended limits compared with only 8% using previous conventional technique. 76% required 10 MV to improve coverage and one patient (2%) an opposed posterior field. The mean normalisation depth was 4.5 cm (range 1.9-7.7 cm) compared with pre-set 3 cm of the conventional technique. With CT-volumed technique the whole lung volume exposed to V40%, including the tangential fields, reduced from 10.79% to 9.64% (p < 0.001) but the mean maximum brachial plexus dose increased from 48.9 Gy to 51.6 Gy (p < 0.001). CONCLUSIONS: Dose coverage of the SCF PTV was greatly improved for plans produced from 3DCT volumes compared to field based techniques.

Impact of an education programme for staff working with children undergoing painful procedures.

AIM: Needle phobia is very common in children, particularly in those with chronic illness who may have to endure many painful procedures. A programme developed to educate paediatric healthcare professionals working with children undergoing painful procedures was evaluated to identify: (1) whether the education programme led to an increase in participating clinicians' knowledge and confidence; and (2) the effectiveness of the education programme in changing practice for patient care. METHOD: Five senior house officers undertook the one-hour training provided by the hospital play specialist. Questionnaires were completed by the clinicians at the beginning and end of the programme. Nurses reported on the clinicians' adherence to best practice. Twenty-one children who had undergone painful procedures were interviewed with their parents to assess their levels of pain, distress, satisfaction and coping style. RESULTS: Participants had increased their knowledge of how to work with children undergoing painful procedures. The main changes in knowledge reported by the clinicians were involving the nurse and the play specialist, preparing the equipment out of sight of the child and using distraction techniques. Parents and children reported low levels of distress during painful procedures, high levels of satisfaction with the procedure and listed a number of coping strategies that helped the child, and the parent, to cope during the procedure. Staff reports indicated that the protocol for painful procedures and that techniques such as distraction were being used in the majority of cases to help the child to cope. CONCLUSION: There are useful pain control techniques that can be taught relatively quickly by nursing staff to paediatric healthcare professionals that do make a substantial difference to the care of children.