What do we want? Training! When do we want it? Now? A training needs analysis for adaptive radiotherapy for therapeutic radiographers.

INTRODUCTION: Therapeutic radiographers (TRs) have adapted to the changing requirements and demands of the oncology service and in response to advanced techniques such as on-line adaptive MRI-guided radiotherapy (MRIgRT). The skills required for MRIgRT would benefit many TRs not just those involved in this technique. This study presents the results of a training needs analysis (TNA) for the required MRIgRT skills in readiness for training TRs for current and future practice. METHODS: A UK-based TNA was used to ask TRs about their knowledge and experience with essential skills required for MRIgRT based on previous investigations into the topic. A five-point Likert scale was used for each of the skills and the difference in values were used to calculate the training need for current and future practice. RESULTS: 261 responses were received (n = 261). The skill rated the most important to current practice was CBCT/CT matching and/or fusion. The current highest priority needs were radiotherapy planning and radiotherapy dosimetry. The skill rated the most important to future practice was CBCT/CT matching and/or fusion. The future highest priority needs were MRI acquisition and MRI Contouring. Over 50% of participants wanted training or additional training in all skills. There was an increase in all values for skills investigated from current to future roles. CONCLUSION: Although the examined skills were viewed as important to current roles, the future training needs, both overall and high priority, were different compared to current roles. As the 'future' of radiotherapy can arrive rapidly, it is essential that training is delivered appropriately and timely. Before this can occur, there must be investigations into the method and delivery of this training. IMPLICATIONS FOR PRACTICE: Role development. Education changes for therapeutic radiographers.

Images and images: Current roles of therapeutic radiographers.

INTRODUCTION: Therapeutic radiography is a small profession and has adapted in response to advanced techniques. An increase in on-line adaptive MRI-guided radiotherapy (MRIgRT) will require role extension for therapeutic radiographers (TRs). This study will investigate the current role description for TRs and the activities they currently undertake with regards to MRIgRT. METHOD: A training needs analysis was used to ask TRs about their current roles and responsibilities and essential skills required for MRIgRT. For the purposes of this paper, the authors present the results from the demographics of the individual, their current job title with roles and responsibilities, and experience with decision making and image assessment. Descriptive statistics was used to analyse the data. RESULTS: 261 responses were received (n = 261). Only 28% of job titles listed contained the protected title of 'therapeutic radiographer'. Advanced clinical practice roles were expressed by participants indicating that if a service need is presented, emerging roles will be created. Variation existed across the standardised roles of TRs and this discrepancy could present challenges when training for MRIgRT. TRs are pivotal in image verification and recognition on a standard linac, and skills developed there can be transferred to MRIgRT. Decision making is crucial for adaptive techniques and there are many skills within their current scope of practice that are indispensable for the MRIgRT. CONCLUSION: It has been demonstrated that TRs have a range of roles that cover vast areas of the oncology pathway and so it is important that TRs are recognised so the pivotal role they play is understood by all. TRs have extensive soft-tissue IGRT knowledge and experience, aiding the evolution of decision-making skills and application of off-protocol judgments, the basis of MRIgRT. IMPLICATIONS FOR PRACTICE: Role development and changes in education for therapeutic radiographers.

A record of igneous evolution in Elysium, a major martian volcanic province.

A major knowledge gap exists on how eruptive compositions of a single martian volcanic province change over time. Here we seek to fill that gap by assessing the compositional evolution of Elysium, a major martian volcanic province. A unique geochemical signature overlaps with the southeastern flows of this volcano, which provides the context for this study of variability of martian magmatism. The southeastern lava fields of Elysium Planitia show distinct chemistry in the shallow subsurface (down to several decimeters) relative to the rest of the martian mid-to-low latitudes (average crust) and flows in northwest Elysium. By impact crater counting chronology we estimated the age of the southeastern province to be 0.85 ± 0.08 Ga younger than the northwestern fields. This study of the geochemical and temporal differences between the NW and SE Elysium lava fields is the first to demonstrate compositional variation within a single volcanic province on Mars. We interpret the geochemical and temporal differences between the SE and NW lava fields to be consistent with primary magmatic processes, such as mantle heterogeneity or change in depth of melt formation within the martian mantle due to crustal loading.

Nonequivalent nuclear location of immunoglobulin alleles in B lymphocytes.

Individual B lymphocytes normally express immunoglobulin (Ig) proteins derived from single Ig heavy chain (H) and light chain (L) alleles. Allelic exclusion ensures monoallelic expression of Ig genes by each B cell to maintain single receptor specificity. Here we provide evidence that at later stages of B cell development, additional mechanisms may contribute to prioritizing expression of single IgH and IgL alleles. Fluorescent in situ hybridization analysis of primary splenic B cells isolated from normal and genetically manipulated mice showed that endogenous IgH, kappa and lambda alleles localized to different subnuclear environments after activation and had differential expression patterns. However, this differential recruitment and expression of Ig alleles was not typically seen among transformed B cell lines. These data raise the possibility that epigenetic factors help maintain the monoallelic expression of Ig.

Rewiring of CD40 is necessary for delivery of rescue signals to B cells in germinal centres and subsequent entry into the memory pool.

Memory B-cell development is impaired by in vivo blockade of the CD40-CD40 ligand (CD40L) interaction using human Fc immunoglobulin G1 (IgG1)-mouse CD40 fusion protein (CD40-Ig); however, germinal centre (GC) formation is not. We show here that the block in B-cell differentiation in these mice is at the stage of rescue from apoptosis and exit from the GC. Thus, GC from CD40-Ig-treated mice contain a three- to fourfold higher level of apoptotic cells than found in control mice injected with human IgG1 alone. This increase in apoptosis is not caused by a blockade of the CD40L-mediated rescue signal but is the result of an intrinsic defect of GC B cells in CD40-Ig-treated mice to receive rescue signals via CD40. While anti-CD40 stimulation maintained the viability in culture of GC B cells from control mice, it did not rescue GC B cells from CD40-Ig-treated mice. This data is consistent with the notion that a 'rewiring' of the CD40 molecule is induced by CD40 ligation early in the response and is necessary to allow B-cell rescue from apoptosis when they subsequently enter the GC.

Dendritic cell-derived IL-12 promotes B cell induction of Th2 differentiation: a feedback regulation of Th1 development.

B cells convert what are normally conditions for Th1 differentiation into an environment suitable for Th2 development. This capacity is dependent on CD40 as B cells from CD40-/- mice do not elicit Th2 differentiation. To elucidate the basis of this effect, we surveyed cytokine RNA made by naive B cells after activation with anti-Ig and anti-CD40. Resting B cells make TGF-beta message only, however, 4 days after activation, RNA encoding IL-6, IL-10, and TNF-alpha was found. The expression of these messages was accelerated by 2 days in the presence of IL-12. The relevance of these observations to T cell differentiation was investigated: addition of OVA peptide to splenic cells from DO.11.10 transgenic mice causes most T cells to make IFN-gamma. Coactivation of B cells in these cultures reduces the number of IFN-gamma-producing T cells and increases the number synthesizing IL-4. Abs to IL-6 and IL-10 block the IL-4 enhancement. Dissection of the component APC demonstrated that interaction of B cells with IL-12-producing dendritic cells is crucial for B cell-mediated IL-4 enhancement: Thus, B cells preactivated in the presence of dendritic cells from IL-12-/- mice show little IL-4-inducing activity when used to activate T cells. This immune regulation is initiated by IL-12 and therefore represents a feedback loop to temper its own dominant effect (IFN-gamma induction).

Relationship of boron to gibberellic Acid-induced proliferation in debudded tobacco plants.

Stem applications of gibberellic acid (GA) to debudded tobacco plants (Nicotiona tabacum L., var. One Sucker) produce stem swellings that involve intense proliferation of, primarily, xylem tissue. Withholding boron from GA-treated debudded plants greatly reduces the GA-induced proliferation. This response offers a system for directly demonstrating the effect of boron on xylem formation and lignification that is unconfounded by the effect of boron on elongation growth.

Morphogenic responses of debudded tobacco plants to gibberellic Acid and indole-3-acetic Acid.

Stem applications of indole-3-acetic acid (IAA) or gibberellic acid (GA) did not prevent or alter tumor or teratoma formation in debudded tobacco plants (Nicotiana tabacum L., var. One Sucker). The materials produced intense (in case of GA) and moderate (in case of IAA) stem proliferations when applied to debudded plants but were without effect on intact plants.The results suggest that debudding-tumors are probably not related to or a result of an auxin or gibberellin deficit and that total debudding has a marked physiological effect on the plant. The altered physiological condition of the debudded plant, indicated by its responses to IAA and GA, may likely be related to tumor and teratoma formation.

Tumor and teratoma induction in tobacco plants by debudding.

Stem and root tumors and teratomata may be induced in tobacco plants (Nicotiana tabacum L., var. One Sucker) by total debudding. Intact plants or plants only decapitated produced no tumors or teratomata throughout their life time. These findings suggest a possibly important oncological relationship between normal growth and tumorous growth. Prevention of normal regeneration (apical and axillary shoot growth) incites pathological regeneration (formation of tumors and tumor shoots). Total bud killing or inactivation by ionizing radiation did not incite tumor or teratoma formation.

Substitution of germanium for boron in plant growth.

The observation was confirmed that the addition of germanium dioxide (soluble form) to the nutrient solution can delay for a short time the appearance of boron deficiency symptoms on the shoots of sunflower plants (Helianthus annuus L.). This appeared to be true, however, only under growing conditions in which the plants had a low boron requirement. The delay in the appearance of boron deficiency symptoms by administering germanium was demonstrated in sunflower plants ranging in age from 7 to 20 days. This effect was noted whether the germanium was administered prior to or at the time the plants were transferred to minus-boron nutrient solution.It is proposed that germanium does not truly substitute for boron in metabolic processes of the plant but rather functions through increasing the mobility of soluble boron within the plant and in binding nonmetabolic polyhydroxyl sites thus serving in a sparing role for the limited quantity of soluble boron in the growth centers.