Procedures in rad Onc

[biers6]

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Hey all,

Are there any procedures in Rad Onc besides brachytherapy? Rad Onc seems really intersting, but I'd really like to be able to do something with my hands as well. Challenging procedures would be very welcome.

Thanks.

 

[stephew]

Hey all,

Are there any procedures in Rad Onc besides brachytherapy? Rad Onc seems really intersting, but I'd really like to be able to do something with my hands as well. Challenging procedures would be very welcome.

Thanks.

Well you can make your whole career brachy if you want to. That's the hands on stuff.

 

[biers6]

Is there any skill to it, or is it just stick the seed in? I presume a surgeon opens for you?

Well you can make your whole career brachy if you want to. That's the hands on stuff.

 

[RadOncFever]

Is there any skill to it, or is it just stick the seed in? I presume a surgeon opens for you?

No surgeons involved. Just the anesthesiologist. There is no opening involved since you stick catheters into soft tissue. Radioactive seeds are placed strategically through the catheter to give the right dosimetry to the tumor bed.

 

[biers6]

Thank you -- sounds interesting. So how much technical skill/need for dexterity is there? Are there people who are better and people who are worse? How do you get them out? Is it like Intervnetional radiology where you use x-rays/CT scans to see where you're going?

 

[stephew]

Thank you -- sounds interesting. So how much technical skill/need for dexterity is there? Are there people who are better and people who are worse? How do you get them out? Is it like Intervnetional radiology where you use x-rays/CT scans to see where you're going?

there is a lot of skill but many do it without much training. Some specialize it in. Yes there are those better and worse. For permenant seeds you dont take them out (prostate) for gyne (which is intracavitary often) or sarcoma etc, you pull 'em out. Yes you can use these scans sometimes. some times its direct visualization (sarcoma) sometimes its ultrasound (prostate). some is intraop RT.

 

[biers6]

Thank you.

 

[stephew]

Thank you.

.

 

[stephew]

Thank you.

there is a brachy specialist here who would be happy to email you if youd like to talk about this. Just PM me with your email if so.
S

 

[CaptainJack02]

there is a brachy specialist here who would be happy to email you if youd like to talk about this. Just PM me with your email if so.
S

related question for you, steph...
i saw a t&o the other day and had absolutely no friggin clue what was happening, but of course i didn't get a chance to ask the physicist/physician what was going on. i know there's a little kit and you gotta surgically insert it...i helped a little with the planning on that(t&o's are rare occurrences, apparently) but can ya tell me what the sleeve/kit is needed for, what you're trying to do with a t&o(what areas, etc). i've seen some mammosite planning too and goddang that's some complicated shiznit..there were like 20 points on that. but t&o was pretty simple on the nucletron provided computer...

btw, what software/machines (for imrt and external beam treatment planning) do you guys use at brigham? i'm just curious if tufts is behind the times. we use nomos and pinnacle, both on older machines. kinda sux...

you're like a walking encyclopedia! gotta love it.

cheers
captjack

 

[Psycho Doctor]

there's all sort of brachy...there's also intravacavitary radiation.; there's intra operative brachytherapy, mammosite, implants, etc. Some of it is redundant but it can be really interesting too.

 

[stephew]

related question for you, steph...
i saw a t&o the other day and had absolutely no friggin clue what was happening, but of course i didn't get a chance to ask the physicist/physician what was going on. i know there's a little kit and you gotta surgically insert it...i helped a little with the planning on that(t&o's are rare occurrences, apparently) but can ya tell me what the sleeve/kit is needed for, what you're trying to do with a t&o(what areas, etc). i've seen some mammosite planning too and goddang that's some complicated shiznit..there were like 20 points on that. but t&o was pretty simple on the nucletron provided computer...

btw, what software/machines (for imrt and external beam treatment planning) do you guys use at brigham? i'm just curious if tufts is behind the times. we use nomos and pinnacle, both on older machines. kinda sux...

you're like a walking encyclopedia! gotta love it.

cheers
captjack

hi capt'n. I hope my colleague got back to you. he meant to but sometimes he gets sidelined; let me know.
T&O's are pretty common in the gyne brachy world. where to begin? Basically you are using the tandam to deal with the cervical area and the ovid to the parametrium. you try to get the right sized and shaped T for the uterus, and the largest O that will fit for optimal dosmitety. You pack the vagina to stabilize it all and suture the labia closed to keep it all in. this also moves the bladder out of the way. Your dosimitry must consider dose to rectum and bladder. The keel of the T should be flush agains the cervix and the ovids should be level and parallel on a lateral film. A good chapter to read is the gyn chapter on brachy in Perez or leibel. They can make senc of what you've seen. B&W/DF is hardly cutting edge on the techology right now. We've got a couple of varians and novalis. Hopkins did very nicely w/ their new tomotherapy which is brilliant stuff. We;ve got new stuff coming down the pike (no pub intended) which I think is great but as i dont know if its been made public, ill remain vague.
I'm w/dave wazer regarding mammosite: i dont fully trust it. the dosmetry is worrisome; i've done a couple of catheter placement breast implants and i think its horrible- i think that IMRT dose-escalation will do the same thing without the questionable morbidity and trauma of these procedures once its refined. We're using eclipse here and brain lab for stereotactic. Love brain lab but prefer the planning platform for XRT we used at hopkins- Pinnicle. (sp). But probably just cos i was trained on it.

To be honest im not brachy guru, but this is pretty much what ive seen and decided in my admittedly non-expert view.

 

[pikachu]

is this the same brain lab that does volumes for you?

 

[CaptainJack02]

I'm w/dave wazer regarding mammosite: i dont fully trust it. the dosmetry is worrisome; i've done a couple of catheter placement breast implants and i think its horrible- i think that IMRT dose-escalation will do the same thing without the questionable morbidity and trauma of these procedures once its refined. We're using eclipse here and brain lab for stereotactic. Love brain lab but prefer the planning platform for XRT we used at hopkins- Pinnicle. (sp). But probably just cos i was trained on it.

To be honest im not brachy guru, but this is pretty much what ive seen and decided in my admittedly non-expert view.

hi,

thakns for explaining that to me. the docs never got back to me, but hten again, i saw a few others and actually got to play a role in the actual planning, so i learned that way. but i'm surprised about dosimetry in mammosites - it seemed that the dose distribution was pretty conformal and well defined - did the outcomes not satisfy you or was there something about the process/accuracy of the planning/isodoses that bothered you? i know one of the residents was working on a paper trying to map affected areas on the actual breast to the dose distro on the plan, that shouda tipped something off.

i was curious about this - is tomotherapy THE big thing, pushing all other modalities to the side? are there any other massive advances in machines coming thru rite now? what's a good journal that i can read to keep abreast of advances in radonc? i've been searching in vain for any free online journals cuz i don't intend on paying moolah 🙂

i want to stay in the game(mostly cuz it's so interesting) but also to keep this snowball rolling so when sub i's roll around, i'll hopefully be taken more sreiously (with an existing store of knowledge on the subject) and given a second look 🙂

thanks for your help
captjack

 

[stephew]

is this the same brain lab that does volumes for you?

dont know what you mean?

as for tomo: you have to understand that not only does every techology have some things its better for than others, even every make within a platform; that is the Linac is bread and butter but there are many different kinds all with pluses and minues. So the short answer is no, tomo wont "take over". But its an excellent tool. As for the litereature, its really hard to read even as a physician adn certainly if you aren't. Id suggest lookingh at the manufacturing sites- tomotherapy, varian, cyberknife, gammaknife, seimans, phillips. You can see what features they promote.

 

[cancer_doc]

hi,

i was curious about this - is tomotherapy THE big thing, pushing all other modalities to the side? are there any other massive advances in machines coming thru rite now? what's a good journal that i can read to keep abreast of advances in radonc? i've been searching in vain for any free online journals cuz i don't intend on paying moolah 🙂

captjack

Tomotherapy is a piece of the big pie in the next "revolution" in radiation therapy: IGRT (Image Guidance Radiaton Tx), which includes other platforms such as cone-beam CT-based RT, fiducial-related guidance.

The two recent "revolutions" in external beam RT were 3D Conformal RT and IMRT, which allowed us to improve on the accuracy of our planning and dose manipulation. However, we all know that what we planned to treat does not correlate to what is actually treated, and this is in large part due to dynamic organ/target motion. So with IGRT, the goal is to identify those daily motions and provide real-time adaptive radiotherapy.

Additionally, I predict the future revolution post-IGRT is molecular image-guidance, using PET and next-generation functional/molecular targeting.

I don't think that tomo or IGRT will push all modalities aside. Rather, I think they'll merge and morph into some new monster that'll blow cancer to hell.

 

[stephew]

I think they'll merge and morph into some new monster that'll blow cancer to hell.

bless your optomistic heart. Nixon would be proud.