I know for prostate LDR and HDR there are some often ABS (versus industry) sponsored weeks you can do to gain more experience.
Outside of that, I don't know of any good videos, etc.
I do what I consider a good amount of cervix HDR now out in practice. Here are some little things you can do that help you "learn on the job" if videos or workshops aren't an option:
- Be intamately familiar with your HDR kit (be it tandem/ovoid or tandem/ring). It's obvious, but it's easier to know how things fit together without it crammed into a pelvis. Get the kits out and make sure you know exactly how everything fits together. take it apart, put it back together, etc. The Varian and Elekta kits are a bit different, so get to know which ever ones you have very well. Make sure where applicable you have extra pieces/screws.
- Have a gyn onc sew in a Smitt Sleeve. Go and watch them and see how they do it. See the techniques they use to visualize the cervix - different retractors and speculums you may like to use. See how they grasp the cervix with a tenaculum to help things. Worst case scenario if you can't watch you at least have a Smitt sleeve and if you can find it on speculum exam you can slide a tandem right through it.
I try to sew my own Smitt sleeves but sometime's it's tricky. I had a TON of cervix cases as a resident and still do now in practice, but I still need the gyn oncs to help sometimes, largely on patients with odd anatomy or obese and sometimes on the patients that have had prior LEEP or cones where they have a small remnant cervix with distorted OS anatomy, making my confidence in passing dilators without perforation less. The best academic rad oncs don't really need gyn onc for sounding/Smitt sleeve, but for us mere mortals I do need them on probably 15-20% of my cases.
- Get your hands on one of the kits with the anterior and posterior "paddles." These things are amazing. I was trained on the importance of packing and packing is certainly a skill that can only be done with practice with cases...but these rectal or bladder paddles/retractors are amazing. Y
ou don't have to be a pro at packing if you have these things. Probably considered hearsay for some, but I think these things are amazing.
- I prefer intraop trans abdominal ultrasound when I'm sounding the uterus. Can help prevent uterine perforation and can sometimes guide you on those times when you just see a mess at the cervix with no discernable os and you have to kind of make your own. It helps to fill up the bladder with saline, clamp off a foley, then watch in real time while you're sounding the uterus.
- If all else fails and you don't feel comfortable with these procedures just refer them out. There's no shame in it and brachy is an important part of the therapy you don't want to skimp on.
