Clinical Achievements
The clinical component of UWLAX's dosimetry program is a 12-month, 30-hour-per-week internship at one of UWLAX's clinical partner sites. Students go through a competitive interview process at sites that interest them, and then both students and sites submit ranked preference lists. A matching process determines who will be accepted to the program and who will be invited to apply again the following year.
I am pleased to have been matched with Loyola University Medical Center for my internship, which runs from January 2015 through December 2015.
I am pleased to have been matched with Loyola University Medical Center for my internship, which runs from January 2015 through December 2015.
Case Studies
During my first semester, I compiled two case studies based on cases that I had planned. The cases were chosen based on their educational value to me as I started to learn planning techniques.
My first case study was a breast tangent case in which I gained more experience using field-in-field techniques on a non-homogenous body region that included solid soft tissue, bone, and low density lung tissue. This was also one of the first cases where I learned to use RadCalc as a computerized second check of monitor unit calculations.
My second case study was a rectal case in a patient with a hip prosthesis. I learned how to be creative with field arrangements that avoided passing through the metal, while simultaneously delivering improved conformality in the final plan. I also explored the effects of CT image artifacts on density calculations and found that in this case, perhaps because of the large field, they were not as important as I thought they might be.
During my second semester, we stepped up our case study process by making video slideshows. The goal of our second semester case study was to plan the same patient using two different techniques and then discuss the advantages and disadvantages of each technique for that patient's anatomy and disease. I chose an endometrial cancer case that had to be upstaged after pathology results from a hysterectomy showed that it was more advanced than previously suspected. The new plan called for external beam radiation to the vagina and iliac lymph nodes.
My first case study was a breast tangent case in which I gained more experience using field-in-field techniques on a non-homogenous body region that included solid soft tissue, bone, and low density lung tissue. This was also one of the first cases where I learned to use RadCalc as a computerized second check of monitor unit calculations.
My second case study was a rectal case in a patient with a hip prosthesis. I learned how to be creative with field arrangements that avoided passing through the metal, while simultaneously delivering improved conformality in the final plan. I also explored the effects of CT image artifacts on density calculations and found that in this case, perhaps because of the large field, they were not as important as I thought they might be.
During my second semester, we stepped up our case study process by making video slideshows. The goal of our second semester case study was to plan the same patient using two different techniques and then discuss the advantages and disadvantages of each technique for that patient's anatomy and disease. I chose an endometrial cancer case that had to be upstaged after pathology results from a hysterectomy showed that it was more advanced than previously suspected. The new plan called for external beam radiation to the vagina and iliac lymph nodes.
Affective Evaluations
Each month of the internship, students are evaluated by their clinical supervisors on their performance in the clinic.
Competencies & Observations
The clinical portion of the program is where we get hands-on practical experience with planning and treatment techniques. There are 17 competencies that we must demonstrate by the end of the program, and 4 of them had to be completed by the end of the first semester. During my first semester, I completed 4 Competencies:
During my second semester, I completed 7 more Competencies:
Competency Evaluations:
- Palliative (Spine, Hip, Ribs, etc)
- Intact Breast Tangents
- Pelvis (GYN or other)
- Lung with Boost (conformal)
During my second semester, I completed 7 more Competencies:
- Limb Sarcoma
- Lymphoma
- Electron
- Prostate IMRT
- Prostate with Nodes IMRT
- Abdominal IMRT
- Other (Emergent Case)
Competency Evaluations:
Clinical Lab Projects
During the first clinical semester, we supplemented our on the job clinical training by completing two lab assignments using clinical data. A lung lab assignment examined the dose distribution effects of changing beam energies and using wedges as beam modifying devices. We started with a simple AP/PA setup and then added a third beam. We recorded the effects of each change as we went and then reflected on how the techniques could be used in clinical practice. A rectum lab assignment involved examining the differences between a single PA beam, a three field plan, and a four field box plan with different energies and wedges. With each change in setup, we examined and recorded the change's effects on dose coverage.
Our second semester lab project was focused on the parotid gland and the various techniques that can be used to achieve adequate coverage while sparing nearby organs at risk. The assignment directed us to try a 3D wedge pair, an en face mixed beam with both photon and electrons, and an IMRT technique of our choice. I chose VMAT for the IMRT component. This was a challenging assignment, since it was the first time I had tried to use a mixed beam. I found that both of the photon-only options were much easier to plan, though that may have been because I was endlessly tweaking the electron plan thinking that I would eventually be able to achieve a clean-looking coverage pattern. Perhaps the lesson here was just as much in setting realistic expectations as learning how to point a beam at something.
Our second semester lab project was focused on the parotid gland and the various techniques that can be used to achieve adequate coverage while sparing nearby organs at risk. The assignment directed us to try a 3D wedge pair, an en face mixed beam with both photon and electrons, and an IMRT technique of our choice. I chose VMAT for the IMRT component. This was a challenging assignment, since it was the first time I had tried to use a mixed beam. I found that both of the photon-only options were much easier to plan, though that may have been because I was endlessly tweaking the electron plan thinking that I would eventually be able to achieve a clean-looking coverage pattern. Perhaps the lesson here was just as much in setting realistic expectations as learning how to point a beam at something.
Procedure Logs
During my clinical internship at Loyola University Medical Center, I have been exposed to a wide variety of casework and techniques. Take a look at some of what I've done.
