Shira

This summer I am interning in the Radiation Oncology department at Boston Medical Center. On a typical day I shadow an attending to see consults, patients currently being treated, and follow ups, and the attendings usually let me do at least one thing hands on in a day such as feeling a tumor. Later in the day we usually go to the Physics department where the radiation treatment is planned. Typical radiation is six to eight weeks and is always Monday through Friday. The treatment itself usually lasts for only about ten to twenty minutes each day. It is given over a long period of time so that the body can heal overnight, while the tumor cannot heal this quickly. Each patient’s treatment is designed after a CT scan is taken, and each treatment is unique to that patient. A physicist designs the beams for radiation to focus a large amount on the tumor, while making sure that other organs do not receive too much radiation. This is easier said than done. Radiation beams give off radiation while entering and exiting the body, so usually certain angles work better than others to avoid organs. A program calculates the dose that will be given to outlined areas, and the plan usually has to be reworked a few times to meet the restrictions given by the doctors. After the physicists have finished a plan, the doctor approves it, usually modifying it slightly.

Earlier this week I was able to see Radiosurgery given to the brain. Radiosurgery is the full dose of radiation, usually given over weeks, received in only one session. Since such a high dose is given at once, the setup must be even more precise than normally. To ensure the patient didn’t move, a neurosurgeon screwed a metal headpiece into her skull earlier than morning. The radiation therapists placed her on the couch (the table to lie down on during radiation) and had to keep altering it so it was within .2 mm of the designated coordinates. Since the head vibrates, the distance usually fluctuates between 0 mm and .2 mm. After she was positioned correctly, we went into the radiation control room where they gave the radiation for about a minute, then went back in to move the couch, then gave more radiation. This happened about five times. The radiosurgery itself did not take that long, but since the couch constantly had to be altered, it took about fourty-five minutes total.

--Shira Toister