DOS 773: Clinical Practicum III
Course Description
Students continue to improve their treatment planning and dosimetric skills. This course concentrates on advanced planning methods and quality assurance techniques.
Clinical Projects
This semester students were challenged with planning a craniospinal irradiation. Each student was given the same data set and contours and then allowed to choose the treatment method of their choice based upon researching various craniospinal treatment methods. Once planning was complete the plans were uploaded into the ProKnow scoring system and each student had a score generated for their plan. Students wrote a paper detailing their technique utilized, why this method was chosen and if in the end they would have treated a patient with this method. This paper was submitted into a group discussion for students to provide helpful feedback and learn from each other’s techniques. My craniospinal paper can be found in the link below.
Craniospinal Irradiation Plan
Another project this semester was a advanced treatment technique comparison when treating esophageal cancers. Students were given a presentation by Matthew Palmer CMD at MD Anderson Cancer Center in which he details his SupaFireFly esophagus treatment planning technique. Students were to then copy an esophageal patient within their treatment planning system and utilize Palmer’s SupaFireFly technique and a technique of their own and compare the two in critical structure sparing and target coverage. This paper was also placed into a discussion forum for constructive feedback and to be used as a learning tool between students. My esophageal treatment comparison can be found in the link provided below.
Esophageal Plan Comparisons
One last project asked of students this semester was a ProKnow head and neck study plan. Each student downloaded the same data set and contours. Students were provided with a set of prescriptions and tolerance doses. Once students completed their plans, they were uploaded into the ProKnow scoring system and a grade was generated. Then students were asked to write about their experience planning the head and neck plan, what helped them to improve their plan, what did they learn and how did they feel they could improve their plan. This was once again placed into a discussion forum as a learning tool and an opportunity to give feedback.
Clinical Evaluations
Each month, our clinical preceptors were asked to complete an evaluation of our performance in the clinic based on various factors including communication, accuracy, safety, dependability, application of knowledge and general dosimetry skills. My three evaluations from the fall semester can be found below.
September Evaluation
October Evaluation
November-December Evaluation
Clinical Competencies
In order to complete the medical dosimetry program, we were required to complete 17 competencies. Below are all the competencies I have completed.
Palliative Plan
Nodal Irradiation Plan
Limb Sarcoma Plan
Pelvic Plan
Lymphoma Plan
Intact Breast Tangents Plan
Chest Wall Tangents with Supraclav and PAB Plan
Re-Treat Avoiding an old treatment site
Conformal Lung plan with Boost
Abdominal IMRT Plan
Brain IMRT plan with MRI fusion
Prostate IMRT Plan
Prostate with Nodes IMRT Plan
Head and Neck IMRT Plan
Thoracic IMRT Plan
Electron Beam Plan
Brachytherapy Intracavitary Plan
To view the clinical competencies documentation, select the procedures above.
Service Project Journal
This semester I volunteered with the Greater Clermont Cancer Foundation again in their give back to the community event. The GCCF puts together a music festival each fall to give thanks to the community, that gives so much to the foundation throughout the year. I spent some time volunteering during the day and enjoying the event.
Clermont Music Festival
Case Logs
Our time spent in the clinic is documented in case log entries. These entries are generated into a report that can be viewed to show the types of cases I was able to work on this semester
Case logs from January 2017- December 2017
Case Logs from Fall Semester
Self-Reflection
After each course students are asked to take a moment and self-reflect on what they gained during the course and how it affected their education and growth.
The new knowledge and skills I gained during this clinical semester were the advanced planning techniques of head and neck planning, more so the technique of treating multiple prescriptions to multiple PTVs at once. I was challenged to try this advanced planning with both static and VMAT IMRT techniques to get a feel for the difference that each technique provides. I was able to see the pros and the cons of treating with static IMRT and VMAT.
Skills I hope to learn more about as I enter the workforce include anything anyone is willing to teach me. I want to always be open to learning and taking on new and advanced techniques. I would also like to eventually work on SRS and SBRT plans. I would also like to have some time in a proton planning facility and be able to become competent in both photon and proton.
What I enjoyed most about this clinical rotation was my clinical instructor. He never stopped pushing me to go further and to try harder things. Even when I satisfied all of my competencies he would still try to find “hard” patients for me to try my hand at so that I could advance my skills.
What I struggled with the most throughout this clinical rotation and how I plan to work on it is fusion of images where the patient is in a completely different position than that of the treatment position. I do not feel comfortable enough when I am finished with my fusion to say that the area I fused is what the doctor wants. I find some times I spend a lot of time trying to get the bones on, only to realize that yes that helped but the hot area of the PET scan is extremely different than the bone positioning. Practice is going to be key to perfecting the fusion and better understanding what the physician what's from the fusion will help me to understand which area is best to focus on when fusing.
Other reflective thoughts. I remember this stage of therapy school. The end where you are facing the reality that you do know what you need to know and you are competent enough to do this on your own. It is still just as nerve wracking but I also remember when I began my first therapy job it came naturally because I had been trained well. So even though there is the slight fear of being on my own, I know I have a solid backbone to branch of off through this program and I will be just fine, just as I was when I was a new therapist.
Course Description
Students continue to improve their treatment planning and dosimetric skills. This course concentrates on advanced planning methods and quality assurance techniques.
Clinical Projects
This semester students were challenged with planning a craniospinal irradiation. Each student was given the same data set and contours and then allowed to choose the treatment method of their choice based upon researching various craniospinal treatment methods. Once planning was complete the plans were uploaded into the ProKnow scoring system and each student had a score generated for their plan. Students wrote a paper detailing their technique utilized, why this method was chosen and if in the end they would have treated a patient with this method. This paper was submitted into a group discussion for students to provide helpful feedback and learn from each other’s techniques. My craniospinal paper can be found in the link below.
Craniospinal Irradiation Plan
Another project this semester was a advanced treatment technique comparison when treating esophageal cancers. Students were given a presentation by Matthew Palmer CMD at MD Anderson Cancer Center in which he details his SupaFireFly esophagus treatment planning technique. Students were to then copy an esophageal patient within their treatment planning system and utilize Palmer’s SupaFireFly technique and a technique of their own and compare the two in critical structure sparing and target coverage. This paper was also placed into a discussion forum for constructive feedback and to be used as a learning tool between students. My esophageal treatment comparison can be found in the link provided below.
Esophageal Plan Comparisons
One last project asked of students this semester was a ProKnow head and neck study plan. Each student downloaded the same data set and contours. Students were provided with a set of prescriptions and tolerance doses. Once students completed their plans, they were uploaded into the ProKnow scoring system and a grade was generated. Then students were asked to write about their experience planning the head and neck plan, what helped them to improve their plan, what did they learn and how did they feel they could improve their plan. This was once again placed into a discussion forum as a learning tool and an opportunity to give feedback.
Clinical Evaluations
Each month, our clinical preceptors were asked to complete an evaluation of our performance in the clinic based on various factors including communication, accuracy, safety, dependability, application of knowledge and general dosimetry skills. My three evaluations from the fall semester can be found below.
September Evaluation
October Evaluation
November-December Evaluation
Clinical Competencies
In order to complete the medical dosimetry program, we were required to complete 17 competencies. Below are all the competencies I have completed.
Palliative Plan
Nodal Irradiation Plan
Limb Sarcoma Plan
Pelvic Plan
Lymphoma Plan
Intact Breast Tangents Plan
Chest Wall Tangents with Supraclav and PAB Plan
Re-Treat Avoiding an old treatment site
Conformal Lung plan with Boost
Abdominal IMRT Plan
Brain IMRT plan with MRI fusion
Prostate IMRT Plan
Prostate with Nodes IMRT Plan
Head and Neck IMRT Plan
Thoracic IMRT Plan
Electron Beam Plan
Brachytherapy Intracavitary Plan
To view the clinical competencies documentation, select the procedures above.
Service Project Journal
This semester I volunteered with the Greater Clermont Cancer Foundation again in their give back to the community event. The GCCF puts together a music festival each fall to give thanks to the community, that gives so much to the foundation throughout the year. I spent some time volunteering during the day and enjoying the event.
Clermont Music Festival
Case Logs
Our time spent in the clinic is documented in case log entries. These entries are generated into a report that can be viewed to show the types of cases I was able to work on this semester
Case logs from January 2017- December 2017
Case Logs from Fall Semester
Self-Reflection
After each course students are asked to take a moment and self-reflect on what they gained during the course and how it affected their education and growth.
The new knowledge and skills I gained during this clinical semester were the advanced planning techniques of head and neck planning, more so the technique of treating multiple prescriptions to multiple PTVs at once. I was challenged to try this advanced planning with both static and VMAT IMRT techniques to get a feel for the difference that each technique provides. I was able to see the pros and the cons of treating with static IMRT and VMAT.
Skills I hope to learn more about as I enter the workforce include anything anyone is willing to teach me. I want to always be open to learning and taking on new and advanced techniques. I would also like to eventually work on SRS and SBRT plans. I would also like to have some time in a proton planning facility and be able to become competent in both photon and proton.
What I enjoyed most about this clinical rotation was my clinical instructor. He never stopped pushing me to go further and to try harder things. Even when I satisfied all of my competencies he would still try to find “hard” patients for me to try my hand at so that I could advance my skills.
What I struggled with the most throughout this clinical rotation and how I plan to work on it is fusion of images where the patient is in a completely different position than that of the treatment position. I do not feel comfortable enough when I am finished with my fusion to say that the area I fused is what the doctor wants. I find some times I spend a lot of time trying to get the bones on, only to realize that yes that helped but the hot area of the PET scan is extremely different than the bone positioning. Practice is going to be key to perfecting the fusion and better understanding what the physician what's from the fusion will help me to understand which area is best to focus on when fusing.
Other reflective thoughts. I remember this stage of therapy school. The end where you are facing the reality that you do know what you need to know and you are competent enough to do this on your own. It is still just as nerve wracking but I also remember when I began my first therapy job it came naturally because I had been trained well. So even though there is the slight fear of being on my own, I know I have a solid backbone to branch of off through this program and I will be just fine, just as I was when I was a new therapist.