Kari describes her breast cancer experience as a long journey filled with little blessings – small moments that popped up occasionally to guide her in the right direction. She calls these blessings her “angels,” and she’s not sure where she would be today without them. In fact, one of those angels led her to Provision CARES Proton Therapy.
This story starts the way a lot of cancer stories start. A visit to the doctor for an unrelated issue. A few tests. And then, while trying to solve one problem, the doctor discovers another – a red flag.
That discovery sparks a journey down a road far too many have traveled. First, more trips to the doctor. Then more tests. And then the waiting. Waiting with fear and uncertainty – hoping for the best, but preparing for the worst. Until eventually, the wait is over and the news is in…
Every year in early November, the American Society of Radiologic Technologists (ASRT) celebrates National Radiologic Technology Week. It’s an opportunity to recognize the crucial role that medical imaging and radiation therapy professionals play in patient care and safety. The celebration takes place during the week of November 8, which is the day Wilhelm Conrad Roentgen discovered the x-ray in 1895. CONTINUE READING
It only takes a few minutes for patients to receive their daily proton therapy treatment. However, for each treatment course, there have been hours of prior planning to develop the best treatment plan according to the radiation oncologist’s prescription. Medical dosimetry plays a vital role in proton therapy, helping to create a unique treatment plan comprising of the exact dose, beam angles, and patient positioning aspects required to deliver the appropriate dose volume to the target.
Provision Dosimetrists Win Big with Protons
In honor of National Medical Dosimetrist’s Day, Provision CARES Proton Therapy Knoxville wants to call attention to recent accomplishments of members of our medical dosimetry team. This spring, medical dosimetrists from all over the world participated in a competition to create the best dosimetry plan to treat a specified breast cancer patient. The Provision dosimetrists’ submissions were awarded top scores.
When his boss sent out an email encouraging those in the Provision medical physics department to participate in an international treatment planning competition, Kevin Kirby decided to give it a shot.
Sponsored by ProKnow, a radiation analytics and quality assurance company, the assignment of creating a radiation treatment plan for a head and neck cancer case attracted more than 200 entries.
In the final results, Kirby’s entry ranked 21st among 238 treatment plans, and first among proton therapy entries.
“A perfect score was 150,” said Kirby, a medical dosimetrist at Provision Proton Therapy Center. “I got 144.” The top score was 146.9.
He is the second Provision employee to place high in the ProKnow competition, known as the QADS Plan Study. Samantha Hedrick, a medical physicist, achieved third place out of 124 entries in 2013.
ProKnow develops and sells software to “help improve the standard of care in radiation oncology” through analytical tools and databases that help customers measure and track their planning efforts with a goal of identifying best practices for treating a variety of diseases.
The plan Kirby submitted was scored on a scale of 20+ criteria categories, with the ultimate goal of providing the most dose to the tumor versus the least dose to the surrounding, healthy parts of the body.
Kirby credited his treatment modality, proton therapy, with giving him an edge over competitors using conventional radiation treatment methods.
Proton therapy is particularly suited to treatment of head and neck cancer, because “you are dealing with some very critically sensitive areas to radiation, such as the spine and brain,” Kirby said. “Proton therapy is just one of the top ways to treat one of the most difficult areas to get to in the body.”
“Kevin is an outstanding dosimetrist. Along with the rest of our staff, Kevin’s knowledge and work ethic has kept Provision’s planning capabilities at the forefront of radiation therapy,” said Ben Robison, Provision director of medical physics.
Kirby’s high score got him a phone interview with ProKnow in which he was asked about his personal background and more details about his planning methods. ProKnow is making the interview available via its website. Ranking so high among other treatment plans is quantitative validation that proton therapy and, specifically, the medical care at Provision, is best-in-class, he said.
“There’s a lot of hyperbole,” Kirby said. “This is a blind, metric product that shows our treatment is one of the best in the world. It just validates what we’re doing here.”
Not too long ago, radiation prescribed for cancer treatment was calculated by physical measurement and mathematic formulas worked out by hand.
Now computers do much of that detail work, but the job of a dosimetrist is as important as ever in making sure patients receive the right dose of radiation in exactly the right place. And thanks to advancements in the field—the development of proton therapy and advanced application technologies such as pencil-beam scanning, sophisticated software modeling platforms and high tech imaging capabilities—patients receive precise, customized therapy that’s the best in the world.
Kevin Kirby is one of six dosimetrists who work at Provision Center for Proton Therapy. These experts in the delivery of radiation for treatment of cancer work with radiation oncologist and physicists to determine the best treatment plan and then ensure its successful delivery, says Kirby, who spoke recently at a patient chat, held each Wednesday at the proton therapy center. The talks provide information on a variety of topics of interest to patients and their families.
“Our job is to create (proton therapy) dosage that focuses just in the tumor,” Kirby says. “We figure out the best way to position the patient so we can minimize any radiation to excess tissue.”
With the pencil beam application ability, calculations must be made to determine the direction and length of path for the protons being channeled to the tumor. In some cases, treatment can be made challenging by the location of the tumor, on the lung, for instance, in which radiation must be administered while the patient is breathing.
“We are able to predict the motion of the lungs by using four-dimensional CT scans to develop the treatment plans,” he says.
A laundry list of equipment and programs are involved in coming up with the unique plan for each patient. In the case of the lung cancer patient, for example, a respiratory device helps plan for treatment between breaths. Medcam marries patient x-rays with CT scans to aid dosimetrists, physicians and physicists in creating the treatment protocol. A software package called “Matrix” serves as quality assurance for treatment before it starts, even sending protons into the nozzle through which they’ll be delivered to the patient. Treatment planning software serves as a “flight simulator, which also allows for changes in the treatment plan based on shifts inside a patients body during the course of therapy. Another program, Mosaiq, records the treatment itself, creating a unique therapy chart for every patient.
Among the team of caregivers, physicians prescribe and monitor treatment, physicists manage the entire process on both the equipment and treatment delivery side and therapists interact directly with patients who are receiving therapy. Dosimetrists, says Kirby, focus specifically on the way radiation—in this case, proton therapy—targets the cancer in the patient’s body.
“We take the prescription the doctor gives and determine how to deliver it,” he says.
Provision Center for Proton Therapy is the star in this movie produced by RaySearch and featuring the company’s software system, RayStation. The system allows physicians create custom and adaptable treatment plans for proton therapy patients.
Provision has been utilizing RayStation for treatment planning since the center opened last year. The result? World-class cancer care.
Many of proton therapy patients ask, “What is dosimetry and what role does it play in my proton therapy treatment?” So, we passed those questions along to the best person to answer them – an actual Medical Dosimetrist at a proton center developed by Provision. The remainder of this blog is his explanation. CONTINUE READING