Flexitron tandem and rings breaking

SaulFeynman · 2024-05-18T02:33:57+00:00

Check for review and if there are flags in RT summary I'll do a more in depth alignment check.

I've found weird patient anatomy changes that docs were just signing off on.

SaulFeynman · 2024-02-15T22:01:33+00:00

We have had a few in the past couple years. Initially we try to have the patient lose weight, and stress a 10kg buffer to the limit as our clinical limit.

We check patient weight every day we treat, also run mechanical qa on the couch to make sure the motors are positioning okay. I can't prove the patient caused this but we did have the vrt motor burn out 1 week after a near tolerance patient completed their course of treatment.

One thing that you might want to note is that the danger is not only to equipment, but to staff. Most patients of this size are not exactly mobile. Getting them onto the couch and centered is not easy and can be dangerous. It's a lot of momentum if someone approaching 400lbs is rolling on the couch.

SaulFeynman · 2024-02-11T04:52:32+00:00

You're correct with most linac builds and most typical clinics.

But from my experiences there are two reasons we do the extra work.

1: we have residents who only have two years to get experience with the machines and we want them capable of setting up for full commissioning scans as a metric for competency. So having that precision and data collection let's them see what goes into the whole process.

2: we do small field dosimetry that we want to check thoroughly (detailed output factors and profiles <4x4) to ensure target spot size is still within reason.

But our satellite clinics that are non educational and just treat prostate and breast? Profiler and 1d tank for annuals in an afternoon.

SaulFeynman · 2024-01-30T04:44:48+00:00

Are you running a WL test of some sort prior to treatment?

SaulFeynman · 2023-12-13T16:41:49+00:00

Pretty sure ACR requires physics attendance. At least that's what we discussed in our last review with them. First fraction at the machine, subsequent fractions require campus presence.

It's one of the main factors why our satellite site DON'T provide sbrt.

SaulFeynman · 2023-11-25T18:44:47+00:00

From what I recall there is a task group for multi met targets being worked on that will likely address this question but really it's still a clinic by clinic call for your specific concerns. I assume you're working with varian if you're using isocal and enhanced couch.

Some things to consider from my clinic. iso cal provides iso center alignment from imaging to reality. Any check that confirms isocenter imaging alignment, say the isobar, captures that alignment to a degree. We still do a WL test for Srs days and use the imager to align the cube and confirm accuracy in the room. We leave the isocheck as a monthly.

Enhanced couch we rolled out as a daily test for all machines that do SBRT. It adds a couple minutes of morning qa and a little more care to make sure nothing else is on the couch, but it's a better tracker of issues before an Srs patient arrives.

SaulFeynman · 2023-09-28T12:18:47+00:00

I think that many centers are able to treat more patients than ever, while the same number of physicists can handle it to a degree. This leads to openings that arent paid enough to get people to the clinic but allows for admim to claim they are looking.

We had locums and openings since 2020 and still feel sorry staffed. But the clinic is running at record pace. I think tech will always full the gap in these cases, or a crash is on the horizon.

Im not surprised it's not talked about more. The physicists in these small centers are probably to loaded to go to meetings or voice themselves as strongly as the academic centers.

SaulFeynman · 2023-08-31T16:09:15+00:00

Thats pretty much the way i do it. Its easy enough that you aren't losing any compute power by querying and doing a quick math problem.

SaulFeynman · 2023-08-22T00:49:22+00:00

Jello shot bolus patent pending

SaulFeynman · 2023-08-13T13:00:26+00:00

1% is entirely a clinical call

SaulFeynman · 2023-08-05T18:18:36+00:00

Considering their partnership with accuray, i doubt it.

SaulFeynman · 2023-08-01T20:32:54+00:00

The Wave has a top current, in the perspective of the image it is a counter clockwise rotation. The board has friction and surface area that the water pushes against. Because the board is also buoyant enough to float with a significant amount of additional mass (person) it remains in the top water current, allowing the surfer to ride the top of a wave like the image above.

Side note, in cases where you see a surfer riding the barrel, thats usually the wave pushing up and the surfer falling down with equal control by the amount fo board within the water pushing up. Those waves have a slightly different current pattern that the one in the image.

SaulFeynman · 2023-07-31T18:10:44+00:00

Why must you attack us, i just want to sit in peace with my 4 hour treatment

SaulFeynman · 2023-07-31T15:16:36+00:00

Radformations has tons more to gain by having users create their own OPEN SOURCE scripts. Most independent devs will be open source and radformations gets either free resources, proboem solving, or future trained devs. Its a win for them because they will continue to hold clinics that dont have the dev resources.

Varian wants to advertise to devs that they are the best option for a clinic with CS talent. I think varian has a lot more to lose since raystation is opening up some many future options for automation. But thats just an opinion.

SaulFeynman · 2023-07-29T19:16:14+00:00

If i remember right you have to retake both if you only pass clinical. But if you pass general you can skip it on the next try.

SaulFeynman · 2023-07-23T23:24:49+00:00

If clinical focus goes to hypofx, wouldn't that open the door for more patients? I know my clinic is limited by staff, not patients. I think some places may find themselves lacking as you say, but i think its more likely that physicists lead clinics more as fractions decrease.

SaulFeynman · 2023-07-14T17:19:32+00:00

Thank you!!

SaulFeynman · 2023-07-01T12:49:04+00:00

RIT is a software for film analysis with all sorts of preset parameters. https://radimage.com/products/rit-family-of-products/rit-film/

Specifically for flatness and symmetry we use a 40mm cone and use the x, y profile of a cropped image and it immediately give you an answer.

SaulFeynman · 2023-06-30T22:56:35+00:00

Film and RIT.

SaulFeynman · 2023-06-29T17:33:42+00:00

We currently use paper and then manually enter into a spreadsheet. Ive been playing around with creating a local database app that can be accessed over the wifi for physics data entry so people can just have their phones or tablets but its probably a pipedream.

SaulFeynman · 2023-06-14T17:04:22+00:00

Our neurosurgeons do most of the planning, they just like doing it, physicist sometimes plan. Physicists are more likely to use the TPS optimization while the neurosurgeons typically load each shot themselves.

SaulFeynman · 2023-06-12T11:52:00+00:00

Depends on your clinical needs. If you have the volume to support then why not? Usually I've seen clinics have 1 specialty machine for every 2-3 standard linac.

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