How important is training in IMRT..CT sim?

[radoncmonkey]

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First off, horray for the return of the monkey!

Second, I have a burning question. How concerned should I be about a program that is deficient in very common technology (ie-IMRT or CT simulation)?

Specifically, if I were to train at a program like this, would I be handicapped when it comes time to look for a job? Would be hard, for example, to pick up IMRT skills as a practicing attending..or does that training really need to come as a resident or you are sunk?

 

[stephew]

i doubt there are many (any?) programs with out CT sim. few without some form of IMRT. I dont know if it would effect youre getting a job- except that these are probably not the standfords and sloan ketterings of the world. (having said that often smaller places get the cutting edge stuff first). i do think it would mean you were a little undertrained (if no CT, severely undertrained) and you'd need ato learn how to use these things before going out in the real world.

 

[Mulletfluf]

As Steph said, I'd imagine there are very few programs without CT sim. Having done CT sims personally, I wouldn't worry about it. The process of CT sim can be grasped in the course of a day or two. From my experience, its department specific so there is a chance you'd have to relearn some of it anyway. If you understand conventional simulations, CT is a breeze. I'm a lowly therapist and med student, but thats my two cents.

 

[stephew]

while generally true that CT is in practice easier than conventional sim, i would say that if somehow you managed a program without ever doing a ct sim, you'd really have to learn how to understand the anatomy and planning from that standpoint. and yes for your boards as well as for reallife.

 

[CNphair]

If I recall, Rush did not have CT sim last year...I remember that being pointed out by several applicants. I imagine that would change soon, if it has not already...

 

[Wallachia]

If I recall, Rush did not have CT sim last year...I remember that being pointed out by several applicants. I imagine that would change soon, if it has not already...

i suspect several departments might not have a dedicated CT sim; but i think it would be extremely unlikely to not have an imrt or 3dcrt program; additionally, more departments are heading toward offering srs

 

[napoleondynamite]

Does Kansas have CT sim? I heard a rumor that they did not..but I don't know for sure.

 

[radoncmonkey]

Georgetown does not have CT sim either.

 

[stephew]

not having a dedicates ct sim isn't a big issue (just an inconvience perhaps). not doing any 3d (ie ct) sim is a serious issue nowadays

 

[stephew]

georgetown of course has the capacity to do ct sims:
http://www.georgetown.edu/departments/radiationmedicine/department_intro.htm

 

[stephew]

as does U kansas
http://www3.kumc.edu/radonc/
"3-dimensional treatment planning"
". The Department also performs stereotactic radiosurgery and stereotactic radiotherapy and intensity-modulated radiation therapy (IMRT)."

 

[stephew]

and rush

http://www.rush.edu/rumc/page-R11689.html
Three-dimensional conformal radiotherapy: Using CT or MRI scans, doctors can visualize tumors better than with standard radiation. With this picture, they can shape and mold multiple beams of radiation to fit the size and shape of a tumor—and treat tumors with pinpoint accuracy.
Intensity-modulated radiation therapy (IMRT): This state-of-the-art treatment allows doctors to fine-tune radiation doses to target tumors and spare more healthy tissue.

 

[stephew]

please look carefully into these things rather than posting incorrect info. its important stuff. thanks.

 

[radoncmonkey]

Are we talking about CT SIM or CT PLANNING? Georgetown does NOT have CT sim, but does have CT planning. They do their sims with fluoroscopy and tradiational plain film x-rays. They then get a CT scan of the patient and use the parameters from the sim and combine them with the CT scan to use for planning.

 

[napoleondynamite]

oops

 

[napoleondynamite]

Yeah, I was under the same impression about Kansas (PLANNING vs. SIM). Anyone know for sure?

I think a discussion of these issues is important and worthwhile. Thanks.

 

[stephew]

ct planning is the important bit.

 

[stephew]

interestingly, the chair of columbia was at harvard today to watch our ct sims- they will be getting a dedicated CT sim there. of course BWH's sims are a bit old fashioned themselves with planning done at the time of sim (with the exception of imrt and CNS where in the moulds are marked). So we're a little old fasioned ourselves.

 

[radonc]

a lot of places do "planning" at the time of sim...at our program the sim therapist, resident, attending, and dosimetrist are present the entire time (for the majority of the sims)...we place the isocenter, drawe volumes & fields, write the prescriptions, etc.

 

[stephew]

i was quite suprised when i got to my attendings job to see they do things that way. it seems like a rather silly thing to do and i dont know how many places do it. I was used to how i was trianed of course (and thought most places did it). You aquire the sim info and then "offline" do your fusion and contouring and placing hte beams on. then the dosimistrists get it and tweak it. it wasnt until my senior year i realized at most places the residents dont even put on the beams. this "online" planning is for the birds though. doesnt give you time to play with things as much.

 

[deleted4401]

I couldn't imagine planning at the time of the sim. Too much stuff to do during the day! How does that work for a head and neck case? There is so much to work through that it very inefficient to do the planning a the time of sim. Offline seems to be more efficient, but maybe there is something to be said for everyone to be involved at the same time.

On a somewhat related note, it's interesting - unlike IM, you don't learn many different 'styles' of treatment planning - at most programs, you usually seem to have one or two lung attendings, one or two breast attendings, one head/neck attending, one way of doing prostate seeds, etc. and over four years you learn one or two people's way of doing something. You end up being so 'shaped' by your particular training program.

-S

 

[stephew]

for imrt they do just mark the mask and let the planning be done later. its only when the pt themselves needs the isocenter set for tattooing which they want to do on the sim. I agree. its a lousy method.

 

[stephew]

this is VERY true. You see it when it comes time to study for boards and get a job out from residency. there are few fields that aer probably this variable in habits out there.

On a somewhat related note, it's interesting - unlike IM, you don't learn many different 'styles' of treatment planning - at most programs, you usually seem to have one or two lung attendings, one or two breast attendings, one head/neck attending, one way of doing prostate seeds, etc. and over four years you learn one or two people's way of doing something. You end up being so 'shaped' by your particular training program.

-S

 

[Adawaal]

I couldn't imagine planning at the time of the sim. Too much stuff to do during the day! How does that work for a head and neck case? There is so much to work through that it very inefficient to do the planning a the time of sim. Offline seems to be more efficient, but maybe there is something to be said for everyone to be involved at the same time.

On a somewhat related note, it's interesting - unlike IM, you don't learn many different 'styles' of treatment planning - at most programs, you usually seem to have one or two lung attendings, one or two breast attendings, one head/neck attending, one way of doing prostate seeds, etc. and over four years you learn one or two people's way of doing something. You end up being so 'shaped' by your particular training program.

-S

Agree with Simul. I can't imagine how broken up my day would be if I had to plan everything at the actual sim. Sure, a quick whack at the GTV if you have a fancy new dedicated CT sim. Basic breast is easy enough to plan at the sim as well. But for cases that require any thought (especially IMRT or Tomotherapy) delineating normal structures, it takes time to do it right.

 

[stephew]

well imrt isnt done at the sim even at our place which has been groaning away from the "plan at sim" approach.