Background: in 2020 the long-lasting effects of the Covid-19 virus were not included in public
messages of risks to public health. Long Covid emerged as a novel and enigmatic illness with a
serious and life changing impact. Long Covid is poorly explained by objective medical tests,
leading to widespread disbelief and stigma associated with the condition. The aim of this organic
research is to explore the physical and epistemic challenges of living with Long Covid.
Methods: Unlike any previous pandemic in history, online Covid communities and ‘citizen
science’ have played a leading role in advancing our understanding of Long Covid. As patient led research of this grassroots Covid community, a team approach to thematic analysis was
undertaken of 66 patient stories submitted online to covid19-recovery.org at the beginning of the
Covid-19 pandemic between April – September 2020.
Results: the overriding theme of the analysis highlights the complexities and challenges of
living with Long Covid. Our distinct themes were identified; the life changing impact of the
condition, the importance of validation, and how, for many, seeking alternatives was felt to be
their only option.
Conclusions: Long Covid does not easily fit into the dominant evidence-based practice and
biomedical model of health, which rely on objective indicators of the disease process. Patient
testimonies are vital to understand and treat Long Covid, yet patients are frequently disbelieved,
and their testimonies not taken seriously leading to stigma and epistemic injustice which
introduces a lack of trust into the therapeutic relationship.
Patient contribution:
The research was undertaken in partnership with our consumer representative(s) and all findings
and subsequent recommendations have been co-produced.

INTRODUCTION: Compassion is a poorly understood concept in diagnostic and therapeutic radiography, but an increase in its focus was recommended in the Francis Report (2013). Much of the healthcare literature including policy and protocol has focussed on benchmarking and individualising compassion. Two separately conducted doctoral research projects, one therapeutic and one diagnostic, aimed to conceptualise compassion in order to understand its meaning and behavioural expression. METHODS: a constructivist approach was taken with appropriate ethical approval. Patients and carers, student radiographers and radiographers took part in interviews and focus groups and tweets were harvested from a Twitter journal club discussion between radiographers of the second author's published literature review. Data were transcribed and analysed thematically. FINDINGS: Key aspects of communication are fundamental to giving compassionate patient-centred care. These include verbal and non-verbal cues, actively listening and engaging and establishing rapport with the patient. Specific skills associated with these are also identified in these studies. CONCLUSION: Keeping the patient as a person at the centre of radiographic practice in the rapidly evolving technical and cultural environment in which it exists requires timely and appropriate behavioural expressions of compassion from radiographers deploying a range of highly specific communication and interpersonal skills. IMPLICATIONS FOR PRACTICE: When undertaking reflective practice, radiographers could consider key aspects of how they communicate with patients, including: verbal (in particular the language they use with patients and their tone of voice); non-verbal (especially eye contact and smiling and their body language). They could also usefully explore and develop skills in reading their patients' body language as well as their own in order to pick up subtle or hidden cues that might suggest a patient is suffering emotionally or psychologically. Finally, they could think about the sort of targeted questions they could ask of patients when welcoming them into the x-ray or treatment room that would both facilitate the procedure and leave the patient feeling that their radiographer had taken a genuine interest in them and their situation. These reflections could then be used to possibly modify their existing communications with their patients.

IntroductionThe Research and Clinical Trials Therapeutic Radiographers network is a College of Radiographers Specialist Interest Group. It was established to develop and facilitate a support network for therapeutic radiographers working in roles which involve the delivery of radiotherapy clinical trials. Its establishment highlighted the challenges faced by therapeutic radiographers employed in these roles. Consequently, the authors sought to formally capture the working landscape of this subsection of the radiographic workforce, aiming to ascertain any potential barriers to professional development and the increase of clinical trials activity by 15% mandated by NHS England.MethodsA Qualtrics survey was designed, pilot tested and distributed to the sixty-two radiotherapy departments across England and the devolved nations. Departments were questioned on the size, structure and the scope of practice of their radiotherapy research and clinical trials team members.FindingsThirty-nine complete responses were received, providing a response rate of 62%, with each region of the UK represented in the survey. The findings demonstrated issues related to the number of posts affecting capacity, contract status jeopardising the security and effectiveness of their role and the activities specific to research and clinical trials being 'bolted on' to existing roles. Although advanced practice was being undertaken by around a third of this workforce the findings established several barriers including individual/teams' capacity and a perceived lack of support for therapeutic radiographers to progress in clinical trials roles.ConclusionThe findings illustrate several important implications which if not addressed may not only hinder UK radiotherapy departments to achieve the national increase of 15% of clinical trial activity over the next three years but also restrict the growth in size and scope of professional practice of the workforce.Implications for practiceThe research and clinical trials workforce need to adopt a collaborative approach to profile raising and establish a standardised professional scope of practice to support growth and recognition of their role.

IntroductionProviding high quality patient care is a worldwide standard of proficiency across the radiographic workforce. As compassion and compassionate behaviours are considered synonymous with patient-centred care, the focus of professional practice throughout healthcare should be on a system that places compassion at its heart. Inadequate care and dispassionate practice have been blamed for failings within the National Health Service. United Kingdom healthcare legislation has been criticised for its failure to provide meaning or clarity to practical compassionate care. Consequently, it has hindered the ability of National Health Service Trusts, service delivery managers and Medical Radiation Technologists to interpret and implement policy recommendations regarding compassionate practice at a local level.AimsTo support the implementation of compassionate legislation, the study sought to understand the perspectives of those in receipt and those delivering compassionate practice. The research aimed to develop a context specific definition of compassion and identify commonly recognised compassionate behaviours. This article reports on the display of compassion through the behaviours of Medical Radiation Technologists.Methods/materialsCo-production underpinned the qualitative methodological inquiry and design of the research. Eleven focus groups were conducted, five with Medical Radiation Technologists three with cancer patients and care-givers and three with student Medical Radiation Technologists. On completion of thematic analysis from those groups, three co-production workshops were conducted, integrating the data to ensure the co-produced findings were equally representative of the perspectives of the three participant groups.ResultsAn understanding of compassionate display is illustrated through the construction of a conceptual framework. The findings established observable behaviours which a Medical Radiation Technologist must engage in to undertake compassionate display. Three compassionate behavioural classifications were established through the analysis; 'embodied connection', 'characteristic expression' and 'indicative communication'. A Medical Radiation Technologist must engage in all the three core behaviours to gain comprehension of the patient and person. Comprehension enables the Medical Radiation Technologist to establish practices that aim to address the compassionate needs of the patient.Discussion/conclusionAdoption of the behaviours by Medical Radiation Technologists should enhance compassionate care received by patients within clinical practice. The conceptual framework provides both a theoretical and practical understanding of compassionate display, making it a valuable tool for training and assessment.

The objective of this study was to compare the dosimetric differences of a population-based planning target volume (PTV)approach and 3 proposed adaptive strategies: plan of the day (POD), patient-specific PTV (PS-PTV), and daily reoptimization (ReOpt). Bladder patients (n = 10)were planned and treated to 46 Gy in 23 fractions with a full bladder in supine position by the standard strategy using a population-based PTV. For each patient, the adaptive strategy was executed retrospectively as follows: (1)POD—multiple distributions of various PTV sizes were generated, and the appropriate distribution based on the bladder of the day was selected for each fraction; (2)PS-PTV—population-based PTV was used for the first 5 fractions and a new PTV derived using information from these fractions was used to deliver the remaining 18 fractions; and (3)ReOpt—distribution was reoptimized for each fraction based on the bladder of the day. Daily dose was computed on all cone beam computed tomographies (CBCTs)and deformed back to the planning computed tomography (CT)for dose summation afterward. V 95_Accu , the volume receiving an accumulated delivered dose of 43.7 Gy (95% prescription dose), was measured for comparison. Mean V 95_Accu (cm 3 )values were 1410 (standard deviation [SD]: 227), 1212 (SD: 186), 1236 (SD: 199), and 1101 (SD: 180)for standard, POD, PS-PTV, and ReOpt, respectively. All adaptive strategies significantly reduced the irradiated volume, with ReOpt demonstrating the greatest reduction compared with the standard (− 25%), followed by PS-PTV (− 16%)and POD (− 12%). The difference in the magnitude of reduction between ReOpt and the other 2 strategies reached statistical significance (p = 0.0006). ReOpt is the best adaptive strategy at reducing the irradiated volume because of its frequent adaptation based on the daily geometry of the bladder. The need to adapt only once renders PS-PTV to be the best alternative adaptive strategy.

Introduction: Interfraction bladder motion is substantial and therefore many different adaptive radiotherapy approaches have been developed to accommodate that motion. Previous studies comparing the efficacy of those adaptive strategies have demonstrated that reoptimization (ReOpt) was dosimetrically superior when compared to Plan of the Day (POD) and Patient-specific PTV (PS-PTV). However, the feasibility of clinical implementation is dependent upon assessment of the resource burden. This study assessed and compared the resource burden of three adaptive strategies. Methods: Using the planning CT and all daily CBCTs of 10 bladder patients, the following adaptive strategies were simulated offline to deliver 46 Gy in 23 fractions: POD, PS-PTV and ReOpt. Additional activities required to execute these strategies compared to a nonadaptive approach were identified and categorized. Time consumed for the execution of each strategy was measured for a single, experienced observer. Results: the time (minutes) consumed to execute the additional activities for PS-PTV, POD and ReOpt was 14.4, 49.1 and 248.5, respectively. In addition to a significantly shorter time spent, all activities associated with PS-PTV were categorized as those that could be performed without the presence of the patient or a treatment room. On the other hand, ReOpt was the most time intensive and all activities were categorized as those that could lead to increasing patient's time in the treatment room and decreasing capacity. Conclusions: Although ReOpt was preferred with respect to improving dosimetry, the heavy resource burden it incurred could be a deterrent for clinical implementation. PS-PTV was the least resource-intensive strategy.

Introduction Radiotherapy has been offered as a multimodality treatment for bladder cancer patients. Due to the significant variation of bladder volume observed throughout the course of treatment, large margins in the range of 20–30 mm have been used, unnecessarily irradiating a large volume of normal tissue. With the capability of visualizing soft tissue in cone beam computed tomography, there is opportunity to modify or to adapt the plan based on the variation observed during the course of treatment for quality improvement. Methods a literature search was conducted in May 2016, with the aim of examining the adaptive strategies that have been developed for bladder cancer and assessing the efficacy in improving treatment quality. Among the 18 identified publications, three adaptive strategies were reported: plan of the day, patient-specific planning target volume, and daily reoptimisation. Results Overall, any of the adaptive strategies achieved a significant improvement in reducing the irradiated volume compared with the nonadaptive approach, outweighing the additional resource required for its execution. Conclusion the amount and the type of resource required vary from strategy to strategy, suggesting the need for the individual institution to assess feasibility based on the existing infrastructure to identify the most appropriate strategy for implementation.

Background Compassion and compassionate care are central to radiographers' professional policy and practice and are congruent with the core values of the National Health Service Constitution. The term compassion however is over-used, ambiguous and vague. This work sought to explore and provide contextual understanding to the term compassion in healthcare. Method Walker and Avant's eight-step model was used as the framework for the concept analysis. Data collection utilised a number of resources including online databases: Medline, CINAHL complete, Scopus, PubMed, PsycINFO, ScienceDirect, Cochrane and DARE; dictionaries, social media, Internet sources, books and doctoral theses. In all, 296 resources were included in the review. Results the concept analysis distinguishes the defining characteristics of compassion within a healthcare context, allowing for associated meanings and behaviours to be outlined aiding understanding of compassion. Compassion in healthcare requires five defining attributes to be present: recognition, connection, altruistic desire, humanistic response and action. Conclusion the findings identify the complexity of the term and subjective nature in which it is displayed and in turn perceived. The concept analysis forms the basis of further research aiming to develop a healthcare explicit definition of compassion within healthcare, specifically cancer care and radiography practices. Lucidity will enhance understanding, facilitating active engagement and implementation into practice.

Aim Deep inspiration breath hold (DIBH) is a method of motion management used in stereotactic ablative body radiotherapy (SABR) for lung tumours. An external gating block marker can be used as a tumour motion surrogate, however, inter-fraction gross target volume (GTV) displacement within DIBH occurs. This study measured this displacement during a reproducible breath hold regime. In addition, factors such as position of the gating block marker were analysed. Methods and materials a total of 121 cone beam computed tomography scans (CBCTs) from 22 patients who received DIBH SABR were retrospectively evaluated and the magnitude of inter-fraction GTV displacement was calculated for each fraction. This data was analysed to assess if any correlation existed between tumour displacement and variation in the gating block marker position on the patient, the amplitude of breath hold (BH) at computed tomography (CT), the amplitude of BH at treatment and the tumour location. The measured tumour displacement was applied to the original planning CT to evaluate the dosimetric effect on surrounding organs at risk (OARs) using cumulative dose volume histograms (DVHs). Results BH amplitude was reproducible within 0 13±0 1 cm (mean±standard deviation). The magnitude of tumour displacement within BH ranged from 0 to 1 52 cm (0 41±0 28 cm). Displacement in the superior-inferior, anterior-posterior and left-right planes were 0 31±0 26 cm, 0 16±0 18 cm and 0 07±0 12 cm, respectively. No statistically significant correlation was detected between tumour displacement within DIBH and the factors investigated. The range of variation in OAR dose was -7 0 to +3 6 Gy with one statistically significant increase in OAR dose observed (oesophagus mean dose increasing by 0 16 Gy). Findings Reproducible BH was achievable across a range of patients. Inter-fraction GTV displacement measured 0 41±0 28 cm. Due to this low level of motion, the correction of soft tissue moves did not adversely affect OAR dose.

Background: This article describes a collaborative project that aimed to develop a patient-centred curriculum in radiotherapy. In the wake of the Francis report in 2013 and a call for compassion to be a central tenet of health programmes, the project was a timely opportunity to enhance the radiotherapy curriculum. Methods: Collaboration between university staff and patients and carers using the service improvement model Plan-Do-Study-Act was the method employed for the curriculum project. Two key discussion forums helped shape the curriculum plan, with module and course evaluation continuing to inform developments. Results: the key outcome of the project is that it has shaped the 'care' theme evident in the current undergraduate programme. Co-production methods resulted in the development of a range of shared classroom activities that focus on experiences, care values and communication strategies. The new curriculum has evaluated positively and the impact of learning is demonstrated both in the classroom and clinical setting. The project team have also influenced recruitment processes and patient and carer involvement in programme approval is embedded. Conclusion: Working together, with patients and carers is an ideal method to enhance the curriculum and reflect the requirements in practice of current health and social care professions. Further developments in student assessment are planned.

Introduction Head and neck cancer patients receiving radiotherapy can experience a number of toxicities, including weight loss and malnutrition, which can impact upon the quality of treatment. The purpose of this retrospective cohort study is to evaluate weight loss and identify predictive factors for this patient group. Materials and methods a total of 40 patients treated with radiotherapy since 2012 at the study centre were selected for analysis. Data were collected from patient records. The association between potential risk factors and weight loss was investigated. Results Mean weight loss was 5 kg (6%). In all, 24 patients lost >5% starting body weight. Age, T-stage, N-stage, chemotherapy and starting body weight were individually associated with significant differences in weight loss. On multiple linear regression analysis age and nodal status were predictive. Conclusion Younger patients and those with nodal disease were most at risk of weight loss. Other studies have identified the same risk factors along with several other variables. The relative significance of each along with a number of other potential factors is yet to be fully understood. Further research is required to help identify patients most at risk of weight loss; and assess interventions aimed at preventing weight loss and malnutrition.

Purpose Cancer Care Ontario has mandated that all health care professionals working within oncology centres in Ontario should routinely screen and address symptoms of anxiety and depression in cancer patients. This study aims to assess the informational needs of radiation therapists (RTs) concerning the discussion and management of anxiety and depression symptoms in patients receiving radiation therapy treatment. It will also attempt to determine whether RTs believe that reviewing patients' self-reported symptoms should be included as part of their routine patient assessment. Methods a questionnaire was initially piloted at the host institution to six randomly chosen RTs and then sent via e-mail to all radiation therapists practising in Ontario, Canada (N = 921). The online questionnaire consisted of multiple choice questions and was divided into the following four themes: (1) RT comfort levels surrounding the topics of anxiety and depression; (2) management of anxiety and depression in cancer patients; (3) further education needed/requested in anxiety and depression symptom management; and (4) the Edmonton Symptom Assessment System (ESAS). Data analyses included the calculation of means and two sample two-sided t tests to examine the relationships between various demographics and responses. Results RTs feel more comfortable in the discussion of issues surrounding anxiety when compared with depression. The most common positive factor affecting RTs' comfort levels addressing emotional distress is previous experience with patients who have expressed these symptoms; whereas, the most common adverse factor affecting comfort levels is the lack of education regarding emotional distress. Eighty-seven percent of RTs would like further education surrounding anxiety and depression symptom management. Seventy-eight percent of RTs agree that ESAS is an important tool for symptom management; however, only 16% actually use this tool in their clinical practice. Conclusions Although RTs within Ontario feel fairly comfortable addressing anxiety and depression symptoms, they have indicated that further education regarding these topics would be useful. Further research into seamlessly incorporating ESAS into RTs' daily practice should be considered.