The impact of peer review on the radiotherapy treatment planning process in the treatment of lung cancer

Background:
Advanced radiotherapy techniques permit accurate delivery of radiotherapy to lung tumours. Improved accuracy increases the possibility of radiotherapy field geographic miss of the tumour. One source of error is the accuracy of target volume (TV) delineation by the clinical oncologist. Colleague peer review of all curative intent lung cancer plans has been mandatory in our institution since May 2013. At least 2 clinical oncologists review plans checking treatment paradigm, TV delineated, dose to tumour and dose to critical organs. We report the impact of peer review on the radiotherapy planning process for lung cancer.

Methods:
The radiotherapy treatment plans of all patients receiving radical radiotherapy were presented at weekly peer review meetings after their TVs volumes were provisionally signed off by the treating consultant or post-fellowship registrar. All cases and any resultant change to the treatment plan were recorded in our prospective peer review database. We present the summary of changes agreed following the peer review process for a 6 month period.

Results:
Fifteen peer review sessions, including 46 patients (36 NSCLC, 10 SCLC) were analysed. An average of 3 cases were discussed per meeting (range 1 5). 24% of treatment courses were changed. In 4% there was a complete change in paradigm
of treatment (1 patient proceeded to induction chemotherapy, 1 patient had high dose palliative radiotherapy). In 16% there was a change in TV delineated and in 9% a change in dose (2 dose reductions and 2 alterations to post-operative dose fractionations).

Conclusions:
Consultant led peer review resulted in a change in a component of the treatment plan for 28% of patients that would not otherwise have taken place. Given this impact, consultant led peer review should be considered as an essential component in the radiotherapy planning process for all patients treated with curative radiotherapy.

Consideration of coastal risk in the Irish spatial planning process

The vulnerability of coastal areas to associated hazards is increasing due to population growth, development pressure and climate change. It is incumbent on coastal governance regimes to address the vulnerability of coastal inhabitants to these hazards. This is especially so at the local level where development planning and control has a direct impact on the vulnerability of coastal communities. To reduce the vulnerability of coastal populations, risk mitigation and adaptation strategies need to be built into local spatial planning processes. Local government, however, operates within a complex hierarchal governance framework which may promote or limit particular actions. It is important, therefore, to understand how local coastal planning practices are shaped by national and supranational entities. Local governments also have to respond to the demands of local populations. Consequently, it is important to understand local populations’ perceptions of coastal risk and its management. Adopting an in-depth study of coastal planning in County Mayo, Ireland, this paper evaluates: (a) how European and national policies and legislation shape coastal risk management at local level; (b) the incorporation of risk management strategies into local plans; and (c) local perception of coastal risks and risk management. Despite a strong steer from supranational and national legislation and policy, statutory local plans are found to be lacking in appropriate risk mitigation or adaptation strategies. Local residents appear to be lulled into a sense of complacency towards these risks because of the low level of attention afforded to them by the local planning authorities. To avoid potentially disastrous consequences for local residents and businesses, it is imperative that this situation is redressed urgently. Based on our analysis, we recommend: the development and implementation of a national ICZM strategy, supported by detailed local ICZM plans; and obliging local government to address known risks in their plans rather than defer them to project level decision making.

The Impact of Colleague Peer Review on the Radiotherapy Treatment Planning Process in the Radical Treatment of Lung Cancer

AIMS: Modern radiotherapy uses techniques to reliably identify tumour and reduce target volume margins. However, this can potentially lead to an increased risk of geographic miss. One source of error is the accuracy of target volume delineation (TVD). Colleague peer review (CPR) of all curative-intent lung cancer plans has been mandatory in our institution since May 2013. At least two clinical oncologists review plans, checking treatment paradigm, TVD, prescription dose tumour and critical organ tolerances. We report the impact of CPR in our institution.

MATERIALS AND METHODS: Radiotherapy treatment plans of all patients receiving radical radiotherapy were presented at weekly CPR meetings after their target volumes were reviewed and signed off by the treating consultant. All cases and any resultant change to TVD (including organs at risk) or treatment intent were recorded in our prospective CPR database. The impact of CPR over a 13 month period from May 2013 to June 2014 is reported.

RESULTS: One hundred and twenty-two patients (63% non-small cell lung carcinoma, 17% small cell lung carcinoma and 20% 'clinical diagnosis') were analysed. On average, 3.2 cases were discussed per meeting (range 1-8). CPR resulted in a change in treatment paradigm in 3% (one patient proceeded to induction chemotherapy, two patients had high-dose palliative radiotherapy). Twenty-one (17%) had a change in TVD and one (1%) patient had a change in dose prescription. In total, 6% of patients had plan adjustment after review of dose volume histogram.

CONCLUSION: The introduction of CPR in our centre has resulted in a change in a component of the treatment plan for 27% of patients receiving curative-intent lung radiotherapy. We recommend CPR as a mandatory quality assurance step in the planning process of all radical lung plans.

Review of the area planning process (a)

The area planning process continues and formal recommendations arising from it are now being brought forward as development proposals to amalgamate or close schools. At this point in the process the Education Committee requested some comment on five different aspects of the process: the impact of Area Planning to date; the validity of the surplus school vacancy calculation methodology; the Annual Area Profile information; the Needs Model (including as appropriate the implications of the Drumragh judgement); possible enhancements to the consultation and communication process;the facilitation of alternative cross-sectoral or cross-border solutions. This paper offers high level comment on each of these issues. In addition, the Education Committee facilitated a stakeholder consultation meeting in Parliament Buildings on 4 February, 2015. The broad themes that emerged in that discussion will also be mentioned in this paper.

Review of the area planning process (b)

This paper offers a commentary on the area planning reports form primary schools published by each of the Education and Library Boards (ELB) in June 2014. The format of the reports are broadly similar for each ELB, although there are some differences amongst them. All provide an overview on the policy context for the area planning process, a statistical picture of the schools in the ELB and detail on the issues considered for sets of schools within the ELB.

Fear and Urban Planning in Ordinary Cities: From Theory to Practice

The paper complements Abu-Orf's theory about violent settings by setting out a theory of fear in urban planning in ordinary urban contexts around three arguments: spatialization of fear; (modernist) spatialities and the encounter and political economies of urban fear. The three theoretical arguments are used to re-frame the planning history of Chelas, an affordable housing district in Lisbon, Portugal, and debate the way fear shapes, and is shaped in turn by, planning practice. Confirming that (growing) fear in ordinary urban contexts is not just an effect of the contemporary organization of cities, the paper argues for a theorization of fear that combines global (hegemonic) and a local (discursive/contingent) perspectives in the theorization of urban fear, and advocates for the need to put fear, and its capacity to create a crisis in urban policy, at the heart of planners' agendas.

Reconsidering neoliberal urban planning intimes of crisis: urban regeneration policy in a "dense" space in Lisbon

In this article, I contribute to recent debates about the concept of neoliberalism and its use as an explanatory concept, through the analysis of urban planning and regeneration policy in Lisbon amidst crisis and austerity. Suggesting a look at neoliberalization from a threefold perspective—the project, governmentalities, and policymaking—I analyze how current austerity-policy responses to the European economic crisis can be understood as a renewed and coherent deployment of neoliberal stances. The article presents implications for urban planning in Lisbon and thus suggests an exploration of the negotiations and clashes of hegemonic neoliberal governmentalities and policies with the local social and spatial fabric. For this exploration, I select a “deviant” case—the Mouraria neighborhood, a “dense” space in which the consequences of policies diverge sharply from expectations. In conclusion, I suggest that neoliberalization (in times of crisis) should be understood as a coherent project compromised by a set of highly ambiguous governmentalities, which bring about contradictory policymaking at the local level.

Urban planning issues related to the development of rail freight

Este trabalho é o relatório de estágio profissional realizado numa companhia francesa de arquitetura, especializado no planeamento urbano, que se-­‐chama AREP. O trabalho desenvolvido teve como objectivo identificar os problemas dos transportes de mercadorias e de logística nas áreas urbanas e da intervenção do planeamento urbano para a mitigação daqueles problemas. Os transportes urbanos de mercadorias são uma prioridade para a definição de políticas num mundo cada vez mais urbanizado. As áreas urbanas necessitam cada vez mais da entrega e recolha de grandes quantidades de mercadorias, resultando na procura de com custos externos elevados e a degradação da qualidade de vida dos residentes. Em 2012, a OECD estimava que as atividades ligadas ao transporte de mercadorias iriam crescer entre 50% e 130% entre 2010 e 2050 nos países da daquela organização. Nos países que não fazem parte da OECD estimava que as atividades iriam crescer entre 250% e 550% durante o mesmo período. Com os problemas já existentes e com o crescimento que está previsto, é importante encontrar soluções que limitem os custos externos e que se encontrem alternativas mais sustentáveis. Tradicionalmente, os formuladores de políticas urbanas tendem a ver os transportes de mercadorias nas áreas urbanas como um problema, em vez de os considerar como um componente essencial do desenvolvimento urbano. Em consequência disso, as políticas implementadas foram desenvolvidas no sentido da restrição na atividade de distribuição de mercadorias. Ao mesmo tempo, os operadores de transporte têm continuado a desenvolver a sua função adequando-­‐se às condições impostas com maiores níveis de eficiência. No entanto, este sucesso tem tido muitos custos externos negativos para a economia, a sociedade e o ambiente. Por isso, os transportes urbanos de mercadorias encontram-­‐se numa tensão constante entre uma logística eficiente e um desenvolvimento urbano sustentável. Hoje, os decisores políticos começam a alterar a perspectiva sobre a intervenção sobre a circulação de transportes de mercadorias, atendendo à sua importância para a economia urbana e, simultaneamente, à necessidade de reduzir os impactes negativos associados ao transporte de mercadorias. Um dos desafios principais é o de compatibilizar as atividades logísticas e os transportes de mercadorias e a preservação das áreas urbanas, minimizando os impactes, garantindo uma boa qualidade de vida para os residentes. Trata-­‐se de um assunto complexo pelos diferentes atores com interesses muitas das vezes conflituantes. A conciliação dos interesses constitui um dos problemas, nomeadamente nas soluções de curto prazo. O espaço disponível para os transportes e as atividades de comércio e serviços emáreas urbanas é limitado. Existe uma grande concorrência sobre o uso do solo urbano entre os diferentes atores.. A necessidade de espaço, conduz a que o sector da logística saía das cidades e se instale nas suas periferias. Esta tendência chama-­‐se ‘logistic sprawl’ e tem vários efeitos negativos, por exemplo, o facto de os veículos terem de percorrer maiores distâncias para os seus clientes nas áreas urbanas. Ao mesmo tempo, os residentes, como consumidores, exigem ter uma grande variedade de produtos disponíveis, esquecendo que para isso há a necessidade de os transportar para e dentro da cidade. Quando as políticas de transportes de passageiros em áreas urbanas se tem vindo a concentrar na alteração modal, do transporte em automóvel para os transportes públicos, ou para a utilização da bicicleta ou a marcha a pé, as políticas de transportes de mercadorias devem igualmente potenciar a utilização de transportes alternativos mais sustentáveis do que o transporte em veículos de mercadorias com motores de combustão interna. Hoje em dia, 75% de todos os transportes de mercadorias por via terrestre a distâncias médias ou longas (mais de 50km), são realizados por via rodoviária. A distâncias mais reduzidas (last mile) essa percentagem é de quase 100%. Estes valores não são compatíveis com um desenvolvimento sustentável. O esforço desenvolvido no sentido da promoção dos modos mais sustentáveis, como a ferrovia e a utilização das vias navegáveis, têm encontrado a oposição das empresas de transporte de mercadorias pois a rodovia é mais flexível (entrega porta-­‐a-­‐porta), com reduzidos custos de utilização de infraestrutura e com custos-­‐fixos mais baixos. Uma cooperação integrada e holística entre os diferentes níveis de governação do território é fundamental, sendo desejável uma maior cooperação entre o sector público e privado. As medidas a implementar têm que ter em conta os problemas a curto e longo prazo. Uma grande variedade de medidas (de regulação, de gestão da infraestrutura, de gestão e ordenamento do território, de promoção e de informação, etc.) têm que ser implementadas e coordenadas em conjunto com o sector privado. As medidas isoladas não resolverão os problemas de transporte de mercadorias na cidade, por isso, o desafio é o de implementar um pacote de medidas diferentes que contribua para uma distribuição das mercadorias mais sustentável, tornando as cidades mais habitáveis. Neste relatório, são discutidas e analisadas as diferentes medidas que podem ser implementadas pelos distintos níveis de governança, incluindo a apresentação de alguns case-­‐studies.

Colonial architectures, urban planning and the representation of Portuguese imperial history

This article proposes a critical analysis of recent interpretations made to the history of architecture and urban planning in the Portuguese colonial context in the twentieth century, particularly in the former African territories. More generally, it intends to explore how the internal history produced by specific fields of activity, such as architecture or urbanism, can reinforce the logic of a national and nationalized history. This effect is due partly to the fact that the legitimacy of these fields is largely dependent on the national identification in the context of activities that are internationalized. I will argue that the specific field of activity, while creating this internal discourse, can directly or indirectly produce representations of the nation, its history and its people on a larger scale, penetrating popular culture and influencing a shared common sense. In the case in question, the internal discourse on architectural and urbanistic works, on authors and styles, eventually reinforces an idealized and idyllic image of Portuguese colonialism.