2 reports follow, first by Ciaran Malone ( Belfast), second by Samir Dawoud (Leeds)

Ciaran Malone (Northern Ireland Cancer Centre, Belfast

From the 19th

to the 23rd

of April

descended on the Palexpo in Geneva, Switzerland for the 2

being recognised as a global financial centre

easy reach of CERN was a unique

ESTRO forum hosted several meetings reflecting the different interdisciplinary aspects of

radiation oncology. The Clinical & Translational

the Physics Biennial meeting, the

Evaluation and Eradication of Normal Tissue effects of radiotherapy)

different disciplines together to

experience.

The scientific experts of the five meetings

including symposia, presidential and joint sessions, teaching lectures and debates spread

over the main auditorium and

physicists, biologists, radiat

international meeting, it was hard not to be overwhelmed with the sheer volume of

interesting talks held in parallel sessions, making it impossible to attend

most of my time within the physics sessions which covered modern and rapidly changing

topics such as dose verification of advanced radiotherapy, small field challenges, image

guided and adaptive radiotherapy, proton dosimetry, the flatt

Figure 1. One of the ten congress rooms that hosted topics throughout the five days.

Intrafraction motion managemen

My current work focuses mainly on

such, I was particularly interested in

radiotherapy to learn more about new concepts and practices in the use

alternatives that are available.

guided radiotherapy and intrafraction motion management

2nd

ESTRO Forum 2013

19-23 April 2103

Geneva, Switzerland 2 reports follow, first by Ciaran Malone ( Belfast), second by Samir Dawoud (Leeds)

Northern Ireland Cancer Centre, Belfast): of April approximately 3,700 delegates from

on the Palexpo in Geneva, Switzerland for the 2nd

ESTRO Forum 2013. Geneva,

being recognised as a global financial centre, a worldwide centre for diplomacy

unique location for such a large and international event.

several meetings reflecting the different interdisciplinary aspects of

Clinical & Translational meeting, the GEC-ESTRO

meeting, the RTT meeting, and the PREVENT (Prediction, Recognition,

aluation and Eradication of Normal Tissue effects of radiotherapy) meeting

disciplines together to facilitate interesting exchanges of knowledge and

The scientific experts of the five meetings compiled an impressive scientific programme

including symposia, presidential and joint sessions, teaching lectures and debates spread

the main auditorium and 10 rooms (figure 1), dedicated to clinicians, med

physicists, biologists, radiation technologists and nurses. As it was my first major

was hard not to be overwhelmed with the sheer volume of

in parallel sessions, making it impossible to attend

thin the physics sessions which covered modern and rapidly changing

topics such as dose verification of advanced radiotherapy, small field challenges, image

guided and adaptive radiotherapy, proton dosimetry, the flattening filter free modality and

intrafraction motion management. Due to

the volume of talks held concurrently

the five days it is impossible to cover

everything and even harder to fit it all into

one article. Thus, I selected

that related to my work

particularly interesting

selection offers a taste of the topics

covered in the ESTRO 2nd

Figure 1. One of the ten congress rooms that hosted topics throughout the five days.

Intrafraction motion management

mainly on intrafraction motion management, specifically 4DCT

was particularly interested in talks related to intrafraction motion and image guided

to learn more about new concepts and practices in the use

alternatives that are available. Over the course of the conference it was clear that

guided radiotherapy and intrafraction motion management are rapidly developing area

2 reports follow, first by Ciaran Malone ( Belfast), second by Samir Dawoud (Leeds)

from over 80 countries

ESTRO Forum 2013. Geneva,

worldwide centre for diplomacy and within

uch a large and international event. The 2nd

several meetings reflecting the different interdisciplinary aspects of

ESTRO-ISIORT meeting,

ENT (Prediction, Recognition,

meeting brought the

interesting exchanges of knowledge and

scientific programme

including symposia, presidential and joint sessions, teaching lectures and debates spread

dedicated to clinicians, medical

as my first major

was hard not to be overwhelmed with the sheer volume of

in parallel sessions, making it impossible to attend everything! I spent

thin the physics sessions which covered modern and rapidly changing

topics such as dose verification of advanced radiotherapy, small field challenges, image

ening filter free modality and

intrafraction motion management. Due to

held concurrently over

the five days it is impossible to cover

and even harder to fit it all into

selected a few talks

o my work or that I found

and hopefully this

offers a taste of the topics nd

Forum.

Figure 1. One of the ten congress rooms that hosted topics throughout the five days.

specifically 4DCT. As

related to intrafraction motion and image guided

to learn more about new concepts and practices in the use of 4DCT and any

t was clear that image

rapidly developing areas of

radiotherapy. For example, I selected three of the talks

interesting:

A “Novel 4DCT technique for breathing motion modelling”

Center for Radiation Oncology, USA)

free images and the ability to generate

Coming from a 4DCT background

irregular breathing artifacts in 4DCT

and deformable registration to determine

breathing phase. All the images are

image geometry and averaged.

deformed to a user specified breathing phase.

this promising technique which

clinical 4DCT protocols.

Currently, in the Northern Ireland Cancer Centre we use 4DC

patients with lung cancer and

Hospital in Dublin I was curious to learn m

ways. A presentation by N.C.M.G. Van der Voort Van

Cancer Centre, Netherlands)

choosing an internal surrogate marker that is moving sy

Her results show that a 4DCT scan is necessary to select markers moving

the tumour and that if the markers

as assessed by 4DCT, the standard deviation of the tracking errors were reduced.

The main sessions and award talks took place in the enormous

arena (figure 2). Aidan J. Cole

Ireland Cancer Centre, Belfast)

received an award for his interesting

work on the “Radiobiological implications

of respiratory motion in the treatment of

lung cancer” presented his engaging

work in the auditorium. The talk mainly

focused on the radiobiological response

to tissue cells in motion as, to date,

vitro studies examining such responses

have only been carried out exclu

under static conditions.

Figure 2. The main auditorium which hosted the opening ceremony,

topics, presidential symposium and award lectures.

, I selected three of the talks in these areas

for breathing motion modelling” presented by

Center for Radiation Oncology, USA) demonstrated a technique that can

free images and the ability to generate low-noise images at arbitrary breathing phases.

Coming from a 4DCT background I was very curious to see how it was possible t

artifacts in 4DCT images. This was achieved using multiple

to determine the tissue motion as a function of the measured

ll the images are then co-registered and are deformed to single reference

image geometry and averaged. This motion model allows the aggregate image

r specified breathing phase. I’m looking forward to learning more about

which helps solve some of the issues and pitfalls

Currently, in the Northern Ireland Cancer Centre we use 4DCT for planning treatments for

patients with lung cancer and having previously worked on a 4DCT project in St.

was curious to learn more about how 4DCT could be utilized

N.C.M.G. Van der Voort Van Zyp (Erasmus MC

Cancer Centre, Netherlands) showed how 4DCT can provide valuable information when

choosing an internal surrogate marker that is moving synchronous to the tumour motion.

Her results show that a 4DCT scan is necessary to select markers moving

markers were excluded based on their non-synchronous motion

the standard deviation of the tracking errors were reduced.

sessions and award talks took place in the enormous auditorium in

Cole (Northern

Ireland Cancer Centre, Belfast), who

received an award for his interesting

“Radiobiological implications

of respiratory motion in the treatment of

presented his engaging

. The talk mainly

focused on the radiobiological response

to tissue cells in motion as, to date, in

uch responses

have only been carried out exclusively

Figure 2. The main auditorium which hosted the opening ceremony, Clinical practice

topics, presidential symposium and award lectures.

hese areas that I found quite

presented by Daniel Low (UCLA

can produce artifact

noise images at arbitrary breathing phases.

s to see how it was possible to eliminate

multiple helical scans

the tissue motion as a function of the measured

and are deformed to single reference

aggregate image to be

m looking forward to learning more about

and pitfalls in using current

planning treatments for

previously worked on a 4DCT project in St. Luke’s

ore about how 4DCT could be utilized in other

Erasmus MC-Daniel den Hoed

provide valuable information when

nchronous to the tumour motion.

Her results show that a 4DCT scan is necessary to select markers moving synchronously to

synchronous motion

the standard deviation of the tracking errors were reduced.

auditorium in the Palexpo

Clinical practice - state of the art

Advances in radiotherapy delivery techniques to improve dose delivery and account for

respiratory motion have been introduced without full concomitant understanding of the

underlying radiobiological response. Thus, the context of the study was to determine

whether tumour motion can impact on cancer cell survival when exposed to clinically

relevant radiotherapy treatments. Results: In his talk, Aidan described a novel in vitro set up

to investigate lung cancer cell survival with respiratory motion. The study found that the

presence of respiratory motion in uniform irradiation did not differ from static conditions

for cell survival. However, when shielding was applied there was significantly higher cell

survival in-field and out-of-field with respiratory motion compared to a static set-up. The

out of field cell kill is mainly due to the “bystander” effect. With the addition of motion this

affect appears to reduce, increasing the fraction of surviving cells out of field. The setup

used is shown in Figure 3 and the results may indicate reduced efficacy of radiotherapy in

regions of inadequate tumour coverage where respiratory motion is present.

Figure 3. Experimental setup from "Radiobiological implications of respiratory motion in the

treatment of lung cancer" Dr. Aidan Cole. Picture shows the experiemental setup for in-field and out-

of-field irradiated areas.

Re-thinking margins

After previously attending a stimulating talk by Marcel van Herk (The Netherlands Cancer

Institute, The Netherlands), I decided to attend his talk on “Re-thinking margins in the daily

IGRT context” and it did not disappoint. Marcel talked about where we should be going with

our margins and how we should be leaving the hard work to the planning system. Marcel

started with a nice overview of the past and methods of selecting margins starting with the

publication of ICRU 50, the differentiation of systematic and random errors and the trade-

off between potentially overdosing with large margins and under dosing with smaller

margins. Marcel then followed with a compelling argument to forget about conventional

margins as we know them for IMRT planning and to implement a probabilistic planning

approach. Marcel proposed that margins should be generated by incorporating the

knowledge about residual uncertainty distributions directly into IMRT planning. Thus, robust

dose distributions can be sculpted that take into account the actual shape of the dose

distribution and location of the organs at risk when generating a ‘margin’.

Dose verification for advanced radiotherapy

Mark Podesta (Maastro, The Netherlands) presented an interesting piece on “Time

dependent pre-treatment verification of VMAT using flattened or flattening filter free

beams”. Pre-treatment verification of VMAT deliveries are difficult, as with dynamic

treatments the field shape, dose-rate and gantry are all varying with time. For static

treatments, misalignments and dose discrepancies are visible using standard tolerances e.g.

3%/3mm. However these deviations can be missed with dynamic treatments as deviations

during the delivery can average out and so are hidden in integrated Portal Dose Images

(PDIs). Mark Podesta and his team added the time dimension into the tolerances e.g.

3%/3mm/3sec to account for the variations the static integrated model would miss. In his

talk Mark described a general calibration method for EPIDs to measure both flattened and

FFF beams in a time dependent manner. Deviations from predicted doses were observed

that are typically hidden in integrated PDIs. They found that typically the first and last

control points deviate most but typically contain relatively low dose compared to the rest of

the plan. With this calibration method one can track the % of in-field failures, as shown in

Figure 4, and help isolate the cause and position of deviations that occur during a VMAT

delivery.

Figure 4. Results from the “Time

dependent pre-treatment

verification of VMAT using flattened

or flattening filter free beams”

presented by Mr. Mark Podesta.

Graph shows deviations in dose vs.

gantry angle. Red designates an over

prediction and blue designates an

under prediction of measured dose

in comparison to calculations.

Debate: Electrons, the lost particle: or are they still in charge?

The debate on whether electrons are a “lost particle” or still a useful modality presented a

different educational environment that was both stimulating and interactive. Due to

developments in photon therapy, some experts consider that electrons have lost some of

their importance in radiotherapy. Therefore, I was curious to see how others felt about the

role of electrons and their future in radiotherapy. In order to argue that the electron

modality is under-used and new developments within electron therapy should be brought

from literature to clinical practice Mikael Karlsson (Umeå Universitet, Sweden) started the

debate with some advanced and novel ways to utilise electrons in radiotherapy. To support

the argument that electrons have once and for all become obsolete, Thomas Mackie

(University of Wisconsin School of Medicine and Public Health) followed with some hard

facts about electrons diminishing role in radiotherapy making the debate both educational

and one that would split the room almost 50/50.

Mikael Karlsson began the debate by showing many examples of how electrons can be used

to form complex dose distributions and the need for a planning system that can optimize

electrons and photons together. For example, using multiple electron energies to produce

an energy modulated electron wedge as shown in Figure 5. One of Mikael’s main points was

that there is an underutilisation of both photons and electrons together, where “a mixed

electron/photon planning technique (E + IMRT) can decrease the normal tissue integral dose

compared to a photon only IMRT plan.” The first few clinical examples shown by Mikael

showed an impressive array of techniques using electrons alone and both electrons and

photons together in a beneficial way. The last area Mikael discussed was methods to modify

the treatment unit to produce much better electron dose distribution that would be more

comparable to photon dose distributions. E.g. Scanning beam or scattering foils at the target

position to reduce penumbra, Helium in the head to reduce air scatter and double focused

MLCs. What I took away from Mikael’s talk was that if the amount of research that was

undertaken in photon radiotherapy was also undertaken to improve electron radiotherapy

then electrons might be far more effective than they are currently.

Figure 5. Slides from Prof. Mikael Karlsson’s talk on the uses of electrons in radiotherapy. Examples

of how electrons can be used to produce complex and useful dose distributions. Right: Examples of

mixing photon and electron fields. Left: Mixing electron fields of different energies to produce a

wedged dose distribution.

Thomas Mackie’s talk followed to show how electrons before IMRT were used for about 5%

of all radiotherapy treatments. However, with the advent of IMRT, electron treatments have

been overshadowed by photon treatments that are easier to plan, more homogeneous and

have smaller dosimetric uncertainties. The talk described the fundamental physical flaws

with using electrons e.g. how electrons as a particle scatter easily and thus leads to a

blurring of the beam penumbra compared to photons, the bremsstrahlung tail and how the

higher electron energies are never used. T. Mackie then continued by showing examples of

how photon treatments could offer similar or even better dose distributions for sites

historically treated with electrons. e.g. To use tomotherapy or multiple tangential fields to

mould the dose distribution around the patients surface rather than using electrons.

The debate ended with strong points from both parties and no unanimous verdict was

reached. However, the debate was quite informative and promoted a lively debate on the

future role of electrons in radiotherapy. Whether we will invest in the software and

technology to optimize and utilize electrons as we currently do with photons, or simply

replace electrons with advanced photon techniques will be an interesting future to be a part

of.

Flattening Filter Free Linacs

The symposium on Flattening Filter Free linacs opened with a talk by Dietmar Georg

(Medical University of Vienna) highlighting the dosimetric challenges present when using

FFF linacs. His talk covered many aspects of FFF beam dosimetry including small field

dosimetry, radiobiology, radiation protection and pre-treatment dose verification. Dietmar’s

talk offered a great starting point for anyone not familiar with the properties of FFF beams

and their potential effects. This presentation was followed with a talk by Antonella Fogliata

(Oncology Institute of Southern Switzerland) who presented a review of the current status

of treatment planning and dose calculations for FFF beams. With a good introduction to the

characteristics of FFF beams the presentation progressed to show many interesting

examples of stereotactic and IMRT plan comparisons through recent published data

between flattened and un-flattened beams. Dr.Fogliata showed that FFF beams, used with

current treatment planning systems, are beneficial not only for stereotactic treatments but

for most other sites due to their high dose per fraction, high dose rate and lower out of field

dose to organs at risk. Following on from this, Alan Hounsell (Northern Ireland Cancer

Centre, Belfast) provided a comprehensive review of the current literature on the

radiobiological implications of FFF beams. The talk introduced some of the radiobiological

concepts used and then addressed three questions in relation to using FFF beams: Does a

change in instantaneous dose rate impact cell survival? Does the reduction in overall

treatment time impact on cell survival and does the reduction in fraction time impact on cell

survival with FFF treatment beams? Prof. Alan Hounsell showed from recent literature that

almost all recent studies, across a wide range of cell lines, agree that changes to the

instantaneous dose rate or pulse repetition frequency for FFF beams are unlikely to alter cell

response, with further careful investigation needed for doses over 10Gy. Finally, Robin

Garcia (Institut Sainte Catherine, France) ended the symposium with a talk highlighting how

care should be taken with FFF beams and that due to the differences between flattened and

un-flattened beams geometric and dosimetric tolerances need to be re-defined. During the

talk, Robin showed several examples, using delta4 phantom measurements and gamma

analysis, the effect of errors in the position, energy and angle of the treatment field,

suggesting that tolerances used for FFF beam QA must be extracted from what we would

consider as clinically acceptable effects.

Conclusions

The 2nd

ESTRO forum in Geneva was an informative and thoroughly enjoyable event and I

am very grateful to IPEM for facilitating my trip to the Forum. The wide variety of

presentation topics meant you were never left short of something to see. When the time

allowed the exhibition showcased a vast sea of new technology and software (a playground

for most radiotherapy physicists) and a place to network with people from radiotherapy and

oncology professions around the world. Due to the proximity of CERN, the biggest particle

accelerator in the world, it allowed for delegates to visit and learn about the linear

accelerators bigger brother, the Large Hadron Collider (LHC). Some pictures of CERN are

shown in Figure 6. For a physicist, this was an opportunity not to be missed!

Figure 6. Images from CERN. Top left: The ATLAS detector building. Top Right: Inside the visitor

centre. Bottom: Model showing the inside of the ATLAS detector.

In summary, the conference was an incredible opportunity which allowed me to present and

share my work in the form of an E-poster and to bring home a wealth of information, ideas

and contacts. It certainly inspired me to work towards attending another conference in the

future.

Samir Dawoud (St James Institute of Oncology - Leeds Teaching Hospitals NHS Trust):

It’s three days before the European Society for Radiotherapy and Oncology (ESTRO) 2013

conference and my colleague is furious. ‘Lunch will be available for purchase and is not

included with your conference fee,’ he exclaims, ‘what do we pay our fees for?’. We laugh

and get back to trip planning but underneath the joke lies a pertinent point; in a climate of

tight budgets and cost cutting more delegates than ever will be asking ‘can I justify the

expense to attend?’. This year, the annual 2nd

ESTRO Forum took place just outside the

beautiful city of Geneva, Switzerland, in the monolithic Palexpo centre (fig 1), which stands

just next to the airport and in the shadow of the Jura mountains (fig 2). The conference aims

to bring together the multi-disciplinary strands of radiotherapy into a single event and foster

interdisciplinary exchange. For the device manufacturers, it’s an opportunity to convince the

community that their latest kit is the last word in patient treatment, which no department

should be without. It’s an exciting prospect but it’s not a cheap one, as the conference fee

(sans lunch) attests to. So how can we qualify ‘value for money’ in relation to such

conferences?

Fig 1 The Palexpo conference venue exterior Fig 2 View of Geneva and Alps from UN

building

I’m a Part 2 radiotherapy physics trainee, so my primary aim is to present my work. ESTRO is

my first opportunity to present research that I have done to the scientific community

allowing me to further develop communication skills essential for a successful career as a

clinical scientist. As an early-career medical physicist, I’m also keen to start building a

bibliography of my own publications and ESTRO seems like the ideal place to start. I will also

be able to broaden my knowledge of radiotherapy practices through the multi-disciplinary

themes offered at the conference. At least, my bursary and study leave applications are

filled with statements like these as I plead my case for why my attendance at ESTRO is ‘value

for money’. In the weeks before the conference I was excited to receive notice of my

successful abstract submission and a little intrigued to read that I would be presenting an E-

poster. An e-poster is simply that; an electronic copy of a poster presented at a conference.

At first glance, the concept sounds quite appealing; one could imagine a dynamic poster,

with animated or video figures designed to clarify key concepts in eye-catching and

informative ways on large screens for delegates to browse at their leisure in a dedicated e-

Hub (I made up the idea of an e-Hub in my head because I’m optimistic and maybe a little

naïve). From the conference organisers’ point of view

the e-poster is an excellent idea; you can accept

more abstracts without the need to hire larger,

costlier exhibition space. I busy myself with my

poster preparations and travel arrangements and

before long I depart Manchester Airport for Geneva.

In order to off-set the cost of travel in and around

Geneva (my hotel is located on the French side of the

border, necessitating an international commute each

day to the conference) I arrange a bike-hire for the

duration of my stay. This turns out to be the best

decision I could have made; I have a swift and

picturesque ride to the conference each morning and

I have the ideal tool to explore bike-friendly Geneva

during my free time (fig 3). At the end of my visit, I’m

so attached to my trusty bike that the walk back to

my hotel feels completely alien and outrageously

time consuming (a distance of about 1 mile).

Fig 3 Me and my conference bike

At my first visit to the conference I am greeted by the cavernous exhibition space, which is

dominated by Elekta’s colossal

show-room-style stand (fig 4).

Centre stage is their latest linac;

the Versa HD. Elekta are making

quite a song and dance over the

Versa HD (figuratively of course,

as opposed to Accuray’s literal

approach; deploying ribbon-

twirling gymnasts on day one to

draw attention to their

CyberKnife and Tomotherapy

systems). Fig 4 The conference exhibition space

Away from the exhibition, the lecture sessions run in parallel with 6 streams dedicated to

various topics each day. I spend most of my time in the ‘blue’ stream, which is dedicated to

topics in physics including dosimetry, delivery, imaging and adaptive techniques. It was the

adaptive radiotherapy techniques that interested me most, not because of any personal

specialisation (as a pre-registration trainee I am hardly in a position to be considered an

authority on any subject) but because of the advances that technology has allowed in the

field. Personally, the most memorable example of this came from Tom Depuydt of

Universitair Ziekenhuis (UZ) Brussel, who summarised work using Brainlab’s Vero linac to

deliver dynamic tumour tracking as part of SBRT plans. The Vero is an intriguing machine (fig

5); with the outward appearance of a large-bore CT scanner it is in fact a compact linac

mounted on a ring-style gantry. At either side of the treatment head there are two kV-

imaging tubes, which project orthogonally to each other and 45° either side of the

treatment beam axis. This allows the system to deliver stereo fluoroscopy as well as cone-

beam CT capability. But the Vero’s truly unique feature lies in the directability of the

treatment beam; the accelerator is mounted on a gimbal, which allows the treatment beam

to be steered about a solid angle projected from the treatment head. This allows the

treatment beam to track

targets as they move about

within the field of view

defined by the limits of

movement of the gimbal

system.

Fig 5 Model of the Vero linac

from the Brainlab stand

Meanwhile, Depuydt’s presentation outlined the research and commissioning work

undertaken at UZ Brussel, including quantification of uncertainties associated with dynamic

tumour tracking, correlation of external patient markers to internal fiducial markers and the

OAR dose savings achievable using the technique, which are impressive.

But despite the advanced technology and the meticulous preparation used to achieve such

specialised treatments, a question sprang to mind that I just couldn’t resolve; is it worth it?

This is not to say that current methods of SBRT treatments cannot be improved upon but

the workload associated with the dynamic tumour tracking method seemed considerable.

For example, each such treatment requires implantation of fiducial markers, adding a level

of surgical risk to the patient. Planning time was also quoted as 1 week with the

requirement for generating a dynamically tracked and an ITV-based plan. Furthermore,

despite the Vero’s impressive mechanical versatility it is limited in terms of the types of

treatment it can deliver. It is a single energy machine (6MV) and despite a capable 0.5cm

leaf width projected at isocentre it can only manage a maximum field size of 15x15cm.

Back at the Elekta stand, there is much interest in the Versa HD. Yet despite faster leaf

speeds and flattening filter free modes the Versa HD is essentially the same linac we are

used to underneath newer, sleeker covers. Ironically, this is probably the machine’s greatest

advantage over fancier specialised systems like the Vero; it is able to deliver a wide variety

of treatment types from straight-forward breast parallel opposed pairs through complicated

VMAT plans (where faster leaf speeds should make the most impact) to highly conformal,

high-dose SBRT treatments. It is easy to see how such a machine will fit easily into a busy

radiotherapy centre’s existing workflow rather than commissioning the new techniques and

treatment types necessary to get the most out of a newer-design device for a smaller sub-

set of treatments.

If there is one thing I will take away from ESTRO as a mere Part 2 trainee (aside from the

pens, notepads, lanyards, brochures and breath-mints courtesy of Varian) it is the

realisation that the UK is perhaps not the frontier in terms of technological innovation. And

yet, that is not specifically a bad thing; the NHS has a huge and varied radiotherapy

workload that must be met with a limited budget and in such conditions, the most advanced

solution may not always be the best. I find this to be something of a theme at ESTRO this

year, which culminates with a final day debate entitled the house believes that technology is

the obsession but not the answer, which I am frustrated to miss due to travel arrangements.

With my knowledge/appreciation of radiotherapy suitably expanded and my certificate of

attendance secured (which I assume I need to wave about in frantic rain-dance like ritual to

attain some of those mysterious CPD points), what of my primary aim; to get my first poster

out to the radiotherapy community? After all, this was my personal aim of attending ESTRO,

a chance to practice being a working scientist with things to talk about and results to

disseminate! As self-important as it might sound, presenting my own work is a principal

benefit I’m personally expecting as a delegate in exchange for that lunch-less registration

fee.

Unfortunately, I’m in for some disappointment. After traversing the labyrinth of physical

poster displays I happen upon a row of desktop computers with little screen marked ‘e-

poster viewing stations’ (not quite my e-Hub vision of the future). Searching poster abstracts

returns lists of results but posters are displayed in low resolution and each section is

readable only as pop-out clickable fields. Transition animations between screens slow things

down a bit making review of several posters just that bit more time consuming. Individually,

these are small gripes but they make the e-poster experience a little too frustrating

compared with simply looking at and reading a physical counterpart. Worse still, it appears

that the idea of disseminating results is altogether hampered by ESTRO’s e-poster system.

For each e-poster, delegates have the option of e-mailing themselves or a colleague for

further reference. Following Tim Depuydt’s tumour tracking with Vero presentation I hit the

e-poster station to review some of the works he referenced. I identify six of interest and

click the ‘e-mail poster’ option for each one. Two months after the conference, I’m still

waiting for those e-mails. Something tells me they aren’t coming.

So was ESTRO 2013 ‘value for money’ for a Part 2 trainee like me? Certainly I didn’t feel I

achieved my aims of adequately presenting my work though the e-poster system. In that

respect I would think twice about attending a conference to present work in this format in

the future and that may be of concern to conference organisers. After all, when convincing

delegates to part with their registration fee cash they will need to consider all aspects that

delegates perceive as being of value and balance this against the savings they think they will

make by further limiting the amount of physical poster space. However, as an opportunity

to see the latest developments in radiotherapy technology and to learn about research

undertaken both within the UK and from around the world, ESTRO exceeds all of my

expectations. I am so interested in talking to exhibition stand representatives about their

new devices or fellow delegates eagerly standing next to their physical posters that I hardly

notice that I have missed that lunch I was supposed to buy for myself.