You’ve survived 100% of your worst days, you’re doing great.
1 week of Canadian Radiation Oncology practice. It’s been amazing. Exciting, exhilarating, fun, difficult, eye-opening amongst other things.
I realised when I decided to set myself this task of keeping a blog, I had not anticipated just how hard it would be to actually write about another centers practice without revealing too much about what they do. Confidentiality and all that.
Our first day was spent getting a tour, getting to know the clinical educators (whom were all super nice!) and then thrown straight into the deep end of going on the radiation units: treating patients.
The practice IS both very similiar and the smallest but yet biggest stark differences. At my center in the UK we index the bejesus out of everything: (for obvious and not so obvious reasons) - meaning if you’re on a specific treatment machine, you have to move the actual patient - alot. This takes proper practice; and core strength. I always feel I’d be better at it if I was taller --- but then I probably wouldn’t. When the immobilisation isn’t bolted to the bed - as it wasn’t as often done in Canada -- the patient movement was minimal. Of course, to ensure accurate set-up and reproducibility - they’d cone-beam often daily. But this has many advantages - set-up is quicker, slightly less invasive for the patient without having someone constantly touching them. Of course there’s other trade-offs. This is what I love about radiotherapy. It’s different but gets us all to the same point with different pros & cons. And it fascinates me on who and why we all decide what to do and why.
It was the first time I got to see a HEXAPOD being used. I’ve seen them in research papers, and read about them in SBRT trials - in fact I’ve seen them in photos of immobalization devices not knowing what it actually was. So it was really rad to get to see them in action - and so frequently. As we move forward into more IGRT radiotherapy within the UK, with higher dose escalation and more conformal treatments - the Hexapod is probably going to be one of our vital pieces of immobalization/set-up equipment to help make up for patient rotation.
Day 2 was spent in SIM/Planning. Here they do it abit different, yet very similiar. SIM staff help doctors assess patients, and the doctor decides - often there and then - what type of treatment the patient is going to have (what dose prescription), SIM staff then prepare the room, give the patient a first day chat, prepare/make immobilization, scan, contour the OAR on the plan, send to the doctor, doctor sends the plan back after contouring GTV, CTV & PTVs, the SIM staff then plan all the radiotherapy treatments, send to physics, and someone signs it off & boom. Onto treatment. It’s a busy area. But this is a method used in the UK too. I think it’s obviously very exciting for sim staff.
Day 3: We learnt all about the research going on at the center, the pros and cons, the support, how it’s adapted on set. We learnt about the smoking cessation support program - which is a multidisplinary program - aiming at all patients -- not just cancer patients - to stop smoking and they have a HUGE amount of support available to them. It was really eye opening. I really enjoyed this and now I am eager to see what kind of support is on offer at my center - and in the UK in general. Since a fair amount of public-health money is spent on stopping smoking in the UK --- this could be a good program to try to integrate too. More thoughts on this.
I worked on another treatment unit, and saw varied treatment set-ups and techniques - including a breast treatment on the side! I have never even read about it - so it was exciting. And then I was super lucky enough to try to ABC breath-hold technique --- and i can say it was eye-opening from a patient perspective. We’re hoping to catch up with the rest of Europe in the UK with introducing a more cost affective, less invasive version of ABC - By doing voluntary breath-hold for breast patients to reduce cardiac exposure to enhance life into survivorship. I’m really excited to see this happen - and how we’ll adapt it and make protocols for the technique within my training department.
After this, we checked out the Wellness Center - a center where cancer patients can go for holistic needs and spiritual healing and support groups. It was this calming huge - perpose built house. Whilst on campus, it was not part of the hospital. After a bit of research Katie found out that one of it’s biggest donors/owners? is a pharmacutical company. I think it’s really important that every patients holistic needs are met - cancer patients or not. So I’m curious as to what other support is out there within the Canadian infrastructure.
Day 4: Brachytherapy - brachy is a surgical + internal type of radiotherapy. It’s extremely multidisplinary process, that’s really quite invasive for the patient and intense process. The radiotherapists have a lot more hands on opportunity in the process here in Canada than at home. At home we have an Operating Department Practitioner who takes care of all the other things the radiographer was doing. The more I see brachytherapy - the more I want to move into this area when I qualify. It’s not for everyone, esp if you don’t like blood.
Day 5: Was more onset action. I saw more immobalization I had only read about for my case-discussion. Now I feel like I’m in a way better position and have a newer understanding of our practice. I worked with a radiotherapists who had been working for about 22 years. From Hong-Kong to Canada. It was impressive. She had done and seen so much, seen how it has changed and how the patient contact was the reason why she stays even though she didn’t need to work any more.
Everyone we met just loved their job, and had been in it for 10+ years minimum. They loved teaching and explaining everything they did - and it was really inspiring.
After this we were invited to a MDT meeting where all the doctors come together to go over every single patients case to ensure that they’re getting the best treatment possible. It was awesome because of how they just talked about all the specific anatomical parts and regimes and trials and I was like- shit I actually know this? It’s surprising how much you really learn without even knowing you’re learning it.
So now we’re off to Chicago. I’m sat in an airport - that gives you free wifi and complimentary snacks. And it’s super rad!
Of course our 10 day Toronto adventure wasn’t just clinical. We explored the city from top to bottom. Saw the best Blue Jay’s game ( 4 home-runs!) and endured 35c+ degree weather. Another post all about this though!
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