Week 1 of elective placement:
Kelowna: CAMRT at CARO
After saying goodbye to my sister as she left for her journey back to the UK, it was time for me to head back to Kelowna for the conference part of my elective. A six hour coach journey from Vancouver to Kelowna later and I arrive at my hostel. The weather was pretty poor on arrival but was looking good for the rest of the week (temps between 25-31!) and with the conference being held at the Delta hotel on the waterfront, I really couldnāt complain with the location! The conference ran Wednesday-Saturday with Wednesday being the CAMRT education day. This was my favourite day as it felt most relevant and I had a better understanding of all be topics covered. In the photos you can see the agenda for the day, so I wonāt run through it all in detail but I will pick out the key topics of the day.
First up was the IGRT (image guided radiotherapy) session in conjunction with the CARO residents. I really enjoy the imaging aspect of the job so I was looking forward to this one! During the session we looked at various case studies with cone beam (CT) images for different treatment sites and discussed what was wrong with the image matching. As Iām Elekta trained you can image my relief when XVI images appeared on the screen! Priority matching was discussed as was matching bony anatomy vs soft tissue matching - what is clinically acceptable? At this point I was so grateful for all the hours of training Iāve been given by the radiographers at Nottingham. Itās not something we officially have to cover and be competent in at the moment in our programme but Iāve always felt from year 1 that I need to know it. So many of the patients we see are imaged with cone beam CT now - it would be crazy not to learn and understand it. Anywayā¦questions were put to the delegates about what was wrong with specific images, and although I knew the answers as soon as that microphone came out there was no way my hand was going up! I didnāt want to make a fool of myself in front of all these (qualified!) people on the first day š. However it was reassuring to know that I do in fact know what Iām talking about! As we went through the various case studies the need for understanding what could go wrong was discussed. I found this really useful. As the presenter of the session said - if we know what can go wrong itās much easier to troubleshoot. Therefore this saves time and makes the treatment time quicker for the patient.
The next session was a IGRT debrief with the CAMRT delegates. This was a really interesting part of the day as I got to hear how different centres approach imaging their patients and I was surprised at how much it varied from centre to centre. There were about ten different cancer treatment centres represented from all across Canada. Unfortunately the debrief didnāt have an awful lot of time allocated and so it had to come to an abrupt end. I would have liked to have heard more about what other places are doing and why. An example is that at least one centre hardly uses cone beam CT at all. I found this fascinating as we use it a lot in Nottingham and I couldnāt imagine not using it. But then this is where this elective will come in so useful; Iāve only trained in one centre and so thatās all I know and Iām probably a little closed-minded about doing it other ways. I need to be exposed to other ways of providing treatments so that I have a greater understanding of whatās happening in the treatment world. I think as a student you enter into your own little bubble of your training department as youāre so desperate to learn everything and do it well, when actually thereās many different approaches to radiotherapy out there. I find it all so interesting!
Session 3 was about skincare evidence and practice; looking at radiation induced skin reactions. Again this was another session I was really looking forward to, it affects so many patients and so itās imperative to our training that we know how to manage this side effect properly. A working group had been created to investigate information on the skin care advice given to patients across the different centres and also to look at current research available and potential areas that could be researched in the future. A lot of work on radiation induced skin reactions has been done in the UK in recent years and so the group looked at this information too. I do remember our skincare protocol changing in my first year of training at Nottingham to follow the new guidelines. The findings of this work showed that there are currently large inconsistencies between the information given by radiation therapists, radiation nurses and radiation oncologists. They also discovered that the skin RTOG grading system (and other systems) were being used inconsistently too. A lot of work is going on to address this, and I find it really interesting that Canada has a large number of radiation nurses who help patients with their side effects. In my placement site we have information and support radiographers who are specially trained in this area and they work with the oncology doctors to manage patientās side effects.
From the recent research and evidence, the group have been able to stamp out some of the old skin care guidance. Breast cancer patients are now told that they can wear continue to wear deodorant (before they were advised against this on the side of the affected breast), they can also continue to swim as long as the skin is still intact and there is also more information about the types of skin moisturisers patients should use and how often. Over here in Canada the group are also trying to involve pharmacists in the work too, especially around skin care products. This is a really good idea as this provides more consistent patient information from all sources and provides better care in the community. Like in the UK, skin moisturisers arenāt given to patients; they have to go out and buy it. So with the current huge range in the skincare market its understandable that people get overwhelmed when it comes to choosing a product. If pharmacists are well informed on current evidence based advice, they will be able to help people make an informed choice. Another similarity with the UK is that the centres here canāt really tell them which product to go and buy - they canāt be seen to endorse certain products over other ones on the market. All we can do is provide basic pointers like: no perfume in it, a simple moisturiser with no alcohol content etc. In Nottingham we do give a few different examples of products if the patients ask, we try to suggest options that will be beneficial but also arenāt too expensive to buy.
In the afternoon there was a session on advanced practice for radiation therapists. This was quite an eye opener as I hadnāt realised there isnāt a banding system of radiographers like there is at home. Everyone pretty much works on the same level and so itās difficult to see any career progression whilst working on treatment sets. Whilst I like the idea of everyone working on a level playing field, I think I prefer the banding system back home. But thatās just my personal preference - both systems seem to work well but both have their downfalls too.
The job role has the title of āClinical Specialist Radiation Therapistā (CSRT) and shares some of the responsibilities and activities that typically fall under an oncology doctors remit. Training for the role takes between one and two years and this is undertaken by working closely with the radiation oncologists until the doctor is happy the therapist is competent in the role. I think he role sounds fascinating and although we have different bands of radiographers in the UK, we donāt have anything with this type of responsibility. Having one CSRT in the system has shown to increase capacity in the department by 20% and thereās also a time saving of 15% for the oncology doctors. Internationally there are apparently a lot more advanced practice roles for diagnostic radiographers and so Canada is trying to get advanced radiation therapists on the map too. The types of responsibilities that could fall under the CSRT include; Running their own clinics (with the possibility of having dedicated slots on the CT planning scanners if required), becoming a specialist in palliative care, patient information and education role, discharge co-ordination, and providing training for resident oncologists and other health care professionals
Some of these aspects can be undertaken by band 6/7/8 radiographers in the UK but they arenāt usually trained by the oncologists. Although there are a number of CSRTs working in the east of Canada, this is a new programme for British Columbia and its in the process of being set up at the moment. I think itās a really great opportunity for radiation therapists over here and itās clear to see there is a great benefit to having these expertise placed within centres. It will be interesting to see how this pans out for BC in the years to come!
The last two sessions concentrated on research and how to get your work published. So many radiation therapists (RTs) over here carry out some research of their own, which I think is great. From what I can tell about the UK, there arenāt that many therapists who do this at home. It seems to be a really hot topic in the centres with the RTs being hugely supported by the teams here. Listening to the points raised in these sessions was really useful as I have my dissertation coming up this year and anyone who knows me well knows that research really isnāt my strong point. So I need to do a lot of work on this over the next few months! I took a lot of notes so Iām hoping to put these to good use in my upcoming dissertation prep lectures when Iām back at uni.
So that was the CAMRT@CARO education day! There was a nice drinks reception afterwards where I got chance to talk to a lot more people, which was great. I also met two newly qualified therapists so it was interesting to talk to them about how their course was structured and jobs over here. Oh! I also won a bottle of wine for the best tweet of the day! A great highlight š
Iāll update more on the social aspect and the great people I met in my next post tomorrow. But for now, itās bedtime for meā¦I have an early alarm set ready for clinical tomorrow. Goodnight!