title: Clinical challenges in the implementation of a tomotherapy service for head and neck cancer patients in a regional UK radiotherapy centre.
abstract: OBJECTIVE
  Intensity-modulated radiotherapy (IMRT) is increasingly being used to treat head and neck cancer cases.
  
  
  METHODS
  We discuss the clinical challenges associated with the setting up of an image guided intensity modulated radiotherapy service for a subset of head and neck cancer patients, using a recently commissioned helical tomotherapy (HT) Hi Art (Tomotherapy Inc, WI) machine in this article. We also discuss the clinical aspects of the tomotherapy planning process, treatment and image guidance experiences for the first 10 head and neck cancer cases. The concepts of geographical miss along with tomotherapy-specific effects, including that of field width and megavoltage CT (MVCT) imaging strategy, have been highlighted using the first 10 head and neck cases treated.
  
  
  RESULTS
  There is a need for effective streamlining of all aspects of the service to ensure compliance with cancer waiting time targets. We discuss how patient toxicity audits are crucial to guide refinement of the newly set-up planning dose constraints.
  
  
  CONCLUSIONS
  This article highlights the important clinical issues one must consider when setting up a head and neck IMRT, image-guided radiotherapy service. It shares some of the clinical challenges we have faced during the setting up of a tomotherapy service. Implementation of a clinical tomotherapy service requires a multidisciplinary team approach and relies heavily on good team working and effective communication between different staff groups.
authors.affiliation: Northern Centre for Cancer Care, Freeman Hospital, Freeman Road, Newcastle upon Tyne NE7 7DN, UK. Sanjoy.Chatterjee@nuth.nhs.uk
authors.forename: S
authors.initials: S
authors.lastname: Chatterjee
authors.forename: J H
authors.initials: JH
authors.lastname: Mott
authors.forename: G
authors.initials: G
authors.lastname: Smyth
authors.forename: S
authors.initials: S
authors.lastname: Dickson
authors.forename: W
authors.initials: W
authors.lastname: Dobrowsky
authors.forename: C G
authors.initials: CG
authors.lastname: Kelly
mesh_terms: D002173:Cancer Care Facilities / Q000458:organization & administration; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging / Q000532:radiotherapy*; D005260:Female; D006258:Head and Neck Neoplasms / Q000000981:diagnostic imaging / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D058958:Organs at Risk / Q000000981:diagnostic imaging; D018579:Patient Selection; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted; D050397:Radiotherapy, Intensity-Modulated; D019233:Retreatment; D036542:Tomography, Spiral Computed; D006113:United Kingdom; D015431:Weight Loss