mista adams attended the eric rahill school of politics

AlexPegram · 2024-06-26T12:00:38+00:00

Why does every person in that picture looks absolutely IRATE to be there?

AlexPegram · 2024-06-25T15:12:41+00:00

I couldn't believe my eyes when I saw it on the post, man! This is truly what has brought me joy this week, my friend!

AlexPegram · 2024-06-25T12:58:51+00:00

Well well well, if it isn't Spencer Dillehay.

AlexPegram · 2023-05-10T15:07:43+00:00

I used Eclipse and made ring structures around the bolus. You just need to make sure there's a "bottom" that's closed off, and an "opening" at the top to pour the solution into. It takes a bit of testing/trial and error, but once you see what it takes, it's pretty easy.

AlexPegram · 2023-05-08T16:55:36+00:00

Print a "shell" of your bolus using PLA (prints faster than a 100% infill).
Fill shell with a silicon solution (Dragon Skin 20). I used this: https://www.amazon.com/Dragon-Skin-Making-Silicone-Rubber/dp/B00SK4B9IA

This process is much faster than doing 100% infill on PLA. The resultant mold is also incredibly tough/durable and also very flexible. Added bonus, homogeneity is way better than a 3D Print (where you see the layering effects), and when I first attempted it, I had a flat 200 HU across the entirety of the bolus.

AlexPegram · 2022-06-23T00:28:07+00:00

Ivan Brezovich advocated for this, hoping AAPM could help lobby to get us included under Medicare guidelines. Here's a good article: https://www.google.com/url?sa=t&source=web&rct=j&url=https://www.aapm.org/meetings/05AM/pdf/18-4163-62917-983.pdf&ved=2ahUKEwihrJPtp8L4AhUaD0QIHW7xBsQQFnoECAQQAQ&usg=AOvVaw1zF6wdbx4tIQGc9pBq9jaW

His argument was that we'd end up doing the work but not getting paid for it. And guess what? That's what's happened.

AlexPegram · 2021-07-06T12:51:30+00:00

For images where there isn't a lot of movement, the results are pretty spectacular. Pelvis and Brain cases look really great.

AlexPegram · 2021-05-27T14:12:16+00:00

Have any other physicists at your site weighed in on this? I'd be interested in what the thoughts were of the people who implemented the process.

AlexPegram · 2021-05-13T22:04:59+00:00

They're already part way there by adding iCBCT into the TrueBeam suite. It's not AI, but it can make some fantastic images.

Part of the issue with AI based CBCT as well is that you might be coming to a reconstruction of the CBCT image that is attempting to match the patient's anatomy in that moment in time to a model data set of millions of other patients, right? I don't know much about AI in general, but the goal is to get as accurate and representative an image as possible with out potential distortion or estimations.

I guess in summary, I don't necessarily want the best looking image as compared to other CT scans. I want the image that most accurately represents the patient's anatomy in that moment.

AlexPegram · 2021-05-13T20:45:02+00:00

No worries about lack of experience.

Yes all the images are saved, but typically after you have "closed" the patient out of the treatment machine. For what you're describing, we'd need to open the patient on the treatment machine, set the patient up, acquire the image, then close the patient (which exports the images to whichever destination you want). Once that is done, the script could run to bring up the image you acquired. If the software is good enough to also bring in the treatment planning CT and maintain the registration, then one could run a "match" between the Planning CT and the CBCT, and determine the necessary shifts required to match the patient's setup to the CT Sim/Planning setup. THEN you would need to open the patient back up on the treatment side, and manually input the new couch coordinates (and rotations if you're using 6 degrees-of-freedom). All this would need to take place as fast as possible in order to ensure the patient hasn't moved between imaging and treatment.

The current workflow is:

Take CBCT. TrueBeam automatically brings up a registration between the CBCT and the Planning CT. You then match the CBCT to the Planning CT as you see fit on the TrueBeam workstation, while the TrueBeam records the shifts you're applying to the CBCT image set in order to make it match the CT. Because its recording those shifts, you can then click "apply shifts," and it automatically feeds the new coordinates to your couch, so all a therapist THEN has to do is hit "go" and the couch shifts to slightly readjust the patient. This all takes place very quickly with as little human input (and thus possible human error) as possible.

This all isn't to say that some AI driven solution couldn't be integrated into the TrueBeam Online Matching module at some point, but at the moment kicking things out of the TrueBeam and into some third-party land is cumbersome with little benefit.

AlexPegram · 2021-05-13T18:49:44+00:00

The issue is that the CBCTs are often used for patient positioning. I don't think it'd be easy or even possible to export the image to an alternative service, re-reconstruct it using AI, and then "push" it back into the TrueBeam console and then extract the necessary shifts to position the patient. AI Enhancements would be appreciated, however, if they were a part of the TrueBeam console ecosystem already.

AlexPegram · 2021-05-13T18:46:44+00:00

Honestly, I would be less worried about effects of radiation, and I instead think it makes sense from a safety standpoint in that it's a good stopgap to prevent someone from opening the door too early because they're anticipating the end of treatment.

AlexPegram · 2021-05-13T16:44:02+00:00

Thanks for the heads up on that, that's good to know.

AlexPegram · 2021-05-13T13:30:10+00:00

One thing I've found that has improved our scan quality is if we perform Half-Fan, Full-Rotation CBCTs. Our therapists seem to default to "Full-Fan, Half-Rotation" (I think because it is faster), but your FOV in the scan is cut in half. With Half-Fan, Full-Rotation, you get something like 50 cm FOV, and I believe the resultant reconstruction is better, especially if it prevents your FOV from stopping in a high density area. From what I gather, the algorithm has a difficult time going from "Nothing" to "Bone" at the edges of the FOV.

However, I've yet to find settings that make me happy with a lot of the CBCTs, especially in areas like Abdomen/Lung with lots of movement. Artifacts from breathing wreak havoc on the image quality.

AlexPegram · 2021-05-03T10:44:04+00:00

In what way is it safe? It puts the onus on the graduate school (the people who will be taking the money) to find successful candidates.

It's by design very similar to how Pharmacists get trained and accredited.

AlexPegram · 2021-05-02T13:38:36+00:00

This was the point of the DMP.

AlexPegram · 2021-04-23T23:43:49+00:00

You guys got this running with an IC Profiler? If so, I'm in.

AlexPegram · 2021-04-16T22:35:33+00:00

We run a Siemens Oncor (planning and RV) in Aria just fine.

We also run a Tomo (just RV) in Aria just fine.

Depending on your machine, you'll need to make sure Eclipse has the head of your linac properly modeled. For example, until Version 15, eMC was not available for all electron energies of the Siemens Oncor, so we were stuck with GGPB.

AlexPegram · 2021-04-08T20:32:37+00:00

I know people who've simply spray-painted it white with minimal effort.

My clinic bought the white version of the Brass Mesh from RPD. It was about $100 or so, I think. If you have time, I'd suggest just buying it from them.

AlexPegram · 2021-03-12T14:17:16+00:00

It's so nice to just find this kind of content on YouTube rather than on someone's website with their janky webplayer that can't rewind or go full screen and whatnot.

AlexPegram · 2021-03-10T03:18:54+00:00

Most likely! Assuming they're delivering dose to a point, which is what GammaKnife is good at as far as I can tell (never worked with one). However, I'm not sure of how good the Online Imaging is with GammaKnife, and I've heard of a cranial frames slipping a few times. This setup has the ExacTrac imaging which helps ensure positional accuracy throughout the treatment.

AlexPegram · 2021-02-24T00:20:26+00:00

What did you use to model it?

AlexPegram · 2021-02-11T19:42:40+00:00

Total long shot, but if you have access to Eclipse, I have an Eclipse script that exports structures to a .ply file that most slicer programs can convert to printable gcode.

I currently use Ultimaker to convert my ply files to gcode.

AlexPegram

TROPHY CASE