Radiotheraphy Clinicals

Time flies, indeed when you love what you’re doing. My radiation theraphy (radiotheraphy) clinical has already come to an end and there are still lots of stuff to learn and master. Three weeks in the department is not enough. I’m sure going to miss the patients, the staffs and the linac (linear accelerator) machine. However, it would also be nice to go back to school again and prepare for the last exam this semester. The exam is going to be an oral exam via Zoom. Nerve recking but it saves a lot of time rather than a home exam for eight freaking hours!

Before the radiotheraphy clinical, I thought that this is the same as PET (Positron Emission Tomography) but no it is not. While PET is also used in the Oncology Department, its purpose is different from radiotheraphy. Radiotheraphy is used to treat sickness by killing cancer cells/tumors and relieve pain by ionizing radiation. PET on the other hand is used for visualizing the metabolic and physiological process of the cells in the body. In short, PET is used for imaging and examination only.

The first week in the department was both exciting and challenging for me and my classmate because we never had any lectures yet since this course about radiotheraphy and oncology is a third year course. However, the department’s adviser has given us some of her time and gave us an introduction and short lecture about the department and what radiotherapists do. We were also introduced to our respective supervisors and showed the treatment rooms that we were assigned to. My classmate was assigned at the treatment room for patients with prostate cancer and I was assigned at the treatment room with almost all kinds of cancer patients. Then my supervisor showed me around the department and of course showed me the linac machines. Linacs are used for external beam radiation treatments. External beam radiation treatment means that cancer cells are targeted and shot from the outside of the body. Then before the first week ended I got the chance to “drive” the linac and give my very first radiation treatment to a cancer patient. It was a great feeling and at the same time I was also tensed because it was my first time to operate a linac. 🙂

Varian True Beam at lab 3. A newer linac.

The treatment room I was assigned to has an old linac from 2007. I feel fortunate to be able to operate it because the department is going to replace it soon with a newer one. Unlike the newer models, this linac has two pedals (not in the pictures). Then, the newer ones are of course more automated and quicker. Thus, saving a lot of time and can treat more patients.

The control panel of Rapid Arc

The lab that I’m assigned to. The linac machine is a Varian Rapid Arc system from 2007.

During the second week of the clinical, I was again allowed to operate the linac and my supervisor gave me some “matching” tasks offline on the computer. When we say matching, it means that we match the CT images taken before the radiation dosage planning to the images that we’ve taken during the radiation treatment. Because radiation treatment is not just only done once but multiple times. To avoid unnecessary exposure and damage to other parts of the body or organs, the point of entry should exactly be the same every time.

Then my classmate and I was given short lectures about dosage planning, the software that they use, side effects of radiation theraphy, brachytherapy and hyperthermia treatment. Brachytherapy is an internal radiation treatment using a radioactive material enclosed in a capsule and hyperthermia treatment is a cancer treatment where the cancer cells are heated up at around 40 degrees Celsius to damage and kill the cancer cells. This old hyperthermia chamber (the picture below) is the only one in Norway. We were told that when this machine stops working, the patients who would need hyperthermia treatment should go to Germany because Norway has no plans of replacing it. Financial reasons, I guess?

A hyperthermia chamber.

Since the hyperthermia chamber doesn’t use/emit ionizing radiation, we were allowed to give it a try. Well, at least feel the pressure as the bag is being filled with water.

My classmate Magnus trying out the hyperthermia chamber.

Anyway, I can say that my clinical in the oncology department is a unique experience and very educational. I’ve learned a lot of new stuff and met wonderful people. The days varied as there were no days are the same even though most of the patients that I met are the same. There were the happy shifts and there were some sad as well because some of the patients displayed worsening symptoms and some had to stop the treatment because of the unresponsiveness of the cancer to the radiation.

School Progress (an update)

It’s finally spring break! I couldn’t be happier! This and Christmas break are the only breaks that we get at the school because you know, students taking up bachelor degrees are immortals! Nah, it’s just that we’re adults already and we should do adult stuff like worrying about our future through our assignment. :)) Kidding! Well, it’s the Lenten week (season) so it’s holiday here. I’m grateful for this school-free week because then my body can finally take the time to recuperate. All these roles (I’m a mom, student, gf, bff, friend, daughter, sister and a colleague) are making me insane sometimes because of lack of sleep and the stress I get from the deadlines and trying to have a social life in this time of pandemic.

Anyway, this semester started with the second part of clinicals or OJT (on-the-job training) in the hospital last January. This time I was back at Haukeland University Hospital (HUS) for the CT (Computer Tomography) clinicals for four weeks. I was excited and a bit tensed during the first meeting because I’ve never been on a CT clinical before and the last time I touched a CT scan machine was back in 2018 before I took a maternity leave. My clinicals last year was at the ER in Bergen and at Stavanger University Hospital (SUS) in 2018 and they’re both conventional X-ray clinicals.

One of the CT scan machines at HUS. Siemens Somatom Definition AS

I’m happy that I got another image modality the last time and in the right order too. Because this course always starts with the conventional x-ray then CT, MRI and so forth.

Unlike the conventional x-ray, a CT examination requires more time for the preparation. Depends on what type of CT scan examination, if it is with contrast or without contrast. If it is with contrast, the patient is required to have a PVC (peripheral venous catheter) in one of the arms. In Norway, the radiographer does this preparation. Then, it is also important to pay attention to the allergic reactions and contradictions to the examination.

After the CT clinical, I had to review for the exam that I failed last year. Because of the pandemic, exams are digitalized. Thus, turning the exams into home exams. While this type of exam sounds easy, no it’s not. At least not for me because I have a small kid in the house and radiation physics is not easy. I find it harder and brain draining because the exam load is more than doubled. So don’t tell me that I’m just pushing the button or else I’ll bite you! haha!

The control panel for the Siemens CT scan machine

Moving on, my efforts paid off after the stressful days and nights of reviewing for the exam and now I am qualified for the next clinical and it is after the spring break. This time I would be at the Oncology Department to work with radiation therapy. I’m ecstatic about this clinical since this would be the first time to work with a linear accelerator. At the same time, I’m sure that this is more challenging than my previous clinicals because this time I’m going to work with lots of cancer patients.

Till next update! 🙂

On-the-Job Training

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One of the x-ray labs at SUS

In the past few weeks, I was at my very first OJT at Stavanger University Hospital. I was assigned at the radiology department to take x-rays of patients coming back for a check up. The lab that I was assigned to during the first week is a big one and the most common examination is the pelvis and hips. The patients are mostly elderly and adults, though once in a while we got babies and toddlers too. The first day was the busiest because we had like 30 patients during the shift. Well busy for me since it was my first time. Also, I am a student so I cannot just take all the patients and besides, first day is mostly observation for us students. However, after lunch my supervisor let me take atleast a couple of examinations.

Moving on, after a day I was allowed to both take my own x-rays and to assist the radiographers while they lecture me about the protocols in the department. I found out that there is a difference between theory and what is practiced in the hospital. Also, the hospitals have different set of protocols too, so it is important to read and study them. My supervisor is a hands on one which I appreciate a lot because I heard that some of my classmates had supervisors who did not care about them. Anyway,  she made sure that I learned something from her tips and advice by letting me work independently while she was standing in the back. She only interfered when she saw huge mistakes but other than that I was allowed to do whatever I want as long as I was working according to the guidelines and protocols. At the end of the shift, we talked and discussed what things that I needed to be better at.

The OJT was only three weeks and I can say that I have learned a lot when it comes to working in a hospital, patient care and interaction, the department’s administration routines and radiographer as a profession. The experience has also proved and shown me that working as a radiographer is more than pushing the button. Yes there is the button but it is not the only thing about this profession. Like for instance, an x-ray technician should have knowledge about anatomy, radiation physics, medication, nursing and elderly care.

Other than my supervisor, I also got the opportunity to work with other radiographers in the hospital. I found out that the seniors use some techniques that the newer generation would not. I am grateful that they have shown me how to for example do the projections the other way as well.

To end this post, I want to thank all the radiographers and radiologists who I’ve worked with in this short OJT period. Thank you so much for your knowledge, patience and kindness.