Skill level of Radiation Therapist

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mr bill
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   Posted 11/30/2010 7:03 PM (GMT -6)   
There has been a recent thread regarding the skill level of the surgeon. I was just wondering if there is anything regarding the skill level of the therapist who actually delivers the radiation?
It might be advantageous to know if the therapist deals specifically with PC or if they administer radiation for all types of cancers. Such as Prostate today, breast cancer tomorrow?
 
 
Is it possible to have the therapy designed/setup by oncologist at one facility and administered at another?
 
Mr Bill
 

F8
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   Posted 11/30/2010 7:16 PM (GMT -6)   
my clinic has three doctors and several therapists and they just do PC.  one doctor did my BT.  they also do some mets cases. 
 
ed

mr bill
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   Posted 11/30/2010 7:42 PM (GMT -6)   
Sounds like an ideal situation.
Age 66
BPH since 1996. at least three negative biopsies Erie. Uro did not prescribe finasteride
2007 acute urine retention photoselective vaporize Clev. Clinic
8-9-10 PSA rose to 10.14 with finasteride positive biopsy Cleveland gleason 9, cat & bone scan negative
9-8-10 Robotic prostatectomy at Cleveland. Biopsy 9 nodes, 2 positive,seminal & vas deferens
PSA 3 wk .06, 6 wk <.03

BB_Fan
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   Posted 11/30/2010 7:56 PM (GMT -6)   
I tried to get a radiation oncologist at Dana Farber to plan my treatments, and then have the RT done in CT. They wouldn't do it so I had the RT done in Boston. Locally that radiation oncologists and techs did all types of cancers. I felt better about going to Boston to be treated by PCa specialists. Will I get a better result? Who knows? I just wanted to know that I got the best treatment possible.
Dx PCa Dec 2008 at 56, PSA 3.4
Biopsy: T1c, Geason 7 (3+4) - 8 cores, 4 positive, 30% of all 4 cores.
Robotic Surgery March 2009 Hartford Hospital, Dr Wagner
Pathology Report: T2c, Geason 8, organ confined, negitive margins, lymph nodes negitive - tumor volume 9%, nerves spared, no negitive side effects of surgery.
PSA's < .01, .01, .07, .28, .50. HT 5/10. IMRT 9/10.
PSA's post HT .01, < .01

mr bill
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   Posted 11/30/2010 8:05 PM (GMT -6)   
BB Fan,
That was pobably an excellent choice on your part. I was thinking of asking Cleveland Clinic if they would set up the plan, then have it done at the local Regional Cancer treatment center.  But I am not sure that is a very good idea.
 
 

Post Edited (mr bill) : 11/30/2010 7:08:19 PM (GMT-7)


Purgatory
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Date Joined Oct 2008
Total Posts : 25380
   Posted 11/30/2010 9:19 PM (GMT -6)   
Mr Bill, a lot of that depends where you live and how many facilities there are and how advanced they are. Larger populated areas tend to have more choices. In my region, there is one and one only place to have radiation. They have their own staff of Radiation and Medical Oncologists. None of them were Prostate Cancer specific only, but several had extensive experience with Prostate Cancer cases. Its the Radiation Oncologist that determines your "treatment plan", i.e. how many doses, how much radiation in gys to be delivered etc. The hardware that is used again depends on the center you are using, some are more up to date then others. When it comes down to the treatments, the techs are the ones that operate the hardware and deliver the radiation according to the "plan" that was determined. Generally, you only meet briefly once a week during treatments with your Radiation oncologist. Other than personal recommendations, it would be hard to know for sure who is the best, average, or terrible among the doctors.
Age: 58, 56 dx, PSA: 7/07 5.8, 10/08 16.3
3rd Biopsy: 9/08 7 of 7 Positive, 40-90%, Gleason 4+3
open RP: 11/08, on catheters for 101 days
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos marg
Incont & ED: None
Post Surgery PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, 8/6 .06 11/10 Not taking it
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, 21 Catheters, Ileal Conduit Surgery 9/23/10

BB_Fan
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   Posted 11/30/2010 10:56 PM (GMT -6)   
Going to Boston was a real chore, and expensive. 90 minute train ride each way. One month rail pass was over $900. Also, I couldn't work. Luckily I got short-term disability at 80% of salary. I could have had RT 15 mins from my office in CT. But all in all I am glad I did it. I don't wamt to look back on many "I should have's".
Dx PCa Dec 2008 at 56, PSA 3.4
Biopsy: T1c, Geason 7 (3+4) - 8 cores, 4 positive, 30% of all 4 cores.
Robotic Surgery March 2009 Hartford Hospital, Dr Wagner
Pathology Report: T2c, Geason 8, organ confined, negitive margins, lymph nodes negitive - tumor volume 9%, nerves spared, no negitive side effects of surgery.
PSA's < .01, .01, .07, .28, .50. HT 5/10. IMRT 9/10.
PSA's post HT .01, < .01

English Alf
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Date Joined Oct 2009
Total Posts : 2215
   Posted 12/1/2010 2:11 AM (GMT -6)   
Mr Bill,
There is a difference between the skill needed by the doctors who plan your treatment after studying your CT scan images to work out what they are going to target, and the skill needed by the technicians to press the right keys on the computer to make it do the job. (A bit like the difference between the navigation officer on a warship and the helmsman.)

My treatment plan was worked out on the basis of standard protocols by three doctors who discussed my case during a meeting (where I was not present). One of them explained this when I asked why they had decided to give be 66Gy and not say 60 or 70. (And every day when they put my notes out on the table before each session I could always see one little diagram of the complex pattern of connected squares on an image from the CT Scan showing where the target was, plus another diagram with the 7 lines on it showing where the rays would be aimed from.

What you want regarding RT technicians/nurses are folk who make you feel at ease as they adjust your body while you lie half naked on the table and who give you the impression that they know how to operate machinery. A nervous person with cold hands who doesn't know left from right is to be avoided. My RT technicians/nurses were all brilliant, as evidenced by the fact that I'd see them getting given, hugs and kisses, bunches of flowers or boxes of chocolates by patients who had just finished their sessions (they received Scottish Shortbreads from me).

Choosing where to go is another matter. My surgery was in Amsterdam and when my uro referred me to the RT people it was a case of the department on the other side of the corridor. Which was why I had to travel back and forth to Amsterdam by train for my SRT, yet there's a hospital with a similar machine about a mile from me. So I did ask about the idea of sending the details from Amsterdam to the local place, (it is after all only a set of numbers for a computer) but my team said they insist on keeping everything in house.

One reason not to go elsewhere after the plan has been made is that you will have to see the RT doc for the regular check-ups all through RT anyway. And some guys had to see the doc for an unscheduled appointment when something cropped up during a session. (I was also in the RT waiting room one day when a guy having RT had a minor complication and they were able to send him straight across the hall to the uro department to have a cystogram, which might not have been so easy to deal with if his uro had been 100 miles away.)

Another reason why I can understand them not wanting to pass it over to someone else is that during my sessions they kept measuring the position of everything with x-rays and when differences were noted they got referred back to the planning team for minor adjustments to be made. This is perhaps the most important point.

My uro department and RT department also work very closely together: I was treated at the Netherlands Cancer Institute, a Cancer-only hospital, and my uro's Physician assistant and one of the RT Physician Assistant actually work together on some projects. I felt I was in good hands.

BB - A while back there was also a thread about getting travelling expenses for RT reimbursed via the insurance company. I got about 90% of my fares reimbursed in Holland. I know there are different arrangements in the USA, but did you have to pay for everything?

Alf

BB_Fan
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Date Joined Jan 2010
Total Posts : 1011
   Posted 12/1/2010 6:18 AM (GMT -6)   
I actually checked my medical coverage. It didn't cover travel costs. But now that you bring it up I think that I will file for reimbursement. Iy can't hurt and who knows, they may pay some of it,
Dx PCa Dec 2008 at 56, PSA 3.4
Biopsy: T1c, Geason 7 (3+4) - 8 cores, 4 positive, 30% of all 4 cores.
Robotic Surgery March 2009 Hartford Hospital, Dr Wagner
Pathology Report: T2c, Geason 8, organ confined, negitive margins, lymph nodes negitive - tumor volume 9%, nerves spared, no negitive side effects of surgery.
PSA's < .01, .01, .07, .28, .50. HT 5/10. IMRT 9/10.
PSA's post HT .01, < .01

BB_Fan
Veteran Member


Date Joined Jan 2010
Total Posts : 1011
   Posted 12/1/2010 6:18 AM (GMT -6)   
I actually checked my medical coverage. It didn't cover travel costs. But now that you bring it up I think that I will file for reimbursement. Iy can't hurt and who knows, they may pay some of it,
Dx PCa Dec 2008 at 56, PSA 3.4
Biopsy: T1c, Geason 7 (3+4) - 8 cores, 4 positive, 30% of all 4 cores.
Robotic Surgery March 2009 Hartford Hospital, Dr Wagner
Pathology Report: T2c, Geason 8, organ confined, negitive margins, lymph nodes negitive - tumor volume 9%, nerves spared, no negitive side effects of surgery.
PSA's < .01, .01, .07, .28, .50. HT 5/10. IMRT 9/10.
PSA's post HT .01, < .01

mr bill
Veteran Member


Date Joined Sep 2010
Total Posts : 688
   Posted 12/1/2010 6:40 AM (GMT -6)   
BB,

I may be wrong, but I believe there might be some sort of mileage allowed. by the IRS, under medical expenses that are not reimbursed.
I know it is not much, but better than nothing.
Age 66
BPH since 1996. at least three negative biopsies Erie. Uro did not prescribe finasteride
2007 acute urine retention photoselective vaporize Clev. Clinic
8-9-10 PSA rose to 10.14 with finasteride positive biopsy Cleveland gleason 9, cat & bone scan negative
9-8-10 Robotic prostatectomy at Cleveland. Biopsy 9 nodes, 2 positive,seminal & vas deferens
PSA 3 wk .06, 6 wk <.03

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 12/1/2010 7:48 AM (GMT -6)   
BB, here in the US, you can claim all that travel expense related to your radiation treatments under Medical Expenses when you file your taxes, if it were in a previous year, you can do an ammended return to get the credit.
Age: 58, 56 dx, PSA: 7/07 5.8, 10/08 16.3
3rd Biopsy: 9/08 7 of 7 Positive, 40-90%, Gleason 4+3
open RP: 11/08, on catheters for 101 days
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos marg
Incont & ED: None
Post Surgery PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, 8/6 .06 11/10 Not taking it
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, 21 Catheters, Ileal Conduit Surgery 9/23/10

mr bill
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Date Joined Sep 2010
Total Posts : 688
   Posted 12/1/2010 8:14 AM (GMT -6)   
David,
Can you claim the actual expense or is there a preset allowance, ie. 12 cents per mile for travel.
 
BB is your screen name for baseball fan or BB King?

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 12/1/2010 8:58 AM (GMT -6)   
believe current rate is .13 per mile, plus parking, and there are many other expenses you can claim
Age: 58, 56 dx, PSA: 7/07 5.8, 10/08 16.3
3rd Biopsy: 9/08 7 of 7 Positive, 40-90%, Gleason 4+3
open RP: 11/08, on catheters for 101 days
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos marg
Incont & ED: None
Post Surgery PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, 8/6 .06 11/10 Not taking it
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, 21 Catheters, Ileal Conduit Surgery 9/23/10

142
Forum Moderator


Date Joined Jan 2010
Total Posts : 6949
   Posted 12/1/2010 10:22 AM (GMT -6)   
BB, David -
 
Isn't there a significant minimum before you can write off anything medical? I never have been able to get enough there to make it worth itemizing.
 
My insurance would only pay travel if I could prove that there was no local, in-network facility that offered the service, and even then it had to be more than 150 miles door to door.

compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7205
   Posted 12/1/2010 1:48 PM (GMT -6)   
I may be looking at SRT.
 
I have toyed with doing it at Umich, 125 miles away.
That would be too much of a grind, driving 2 hours each way every day (especially if the fatigue SE kick in).
If I did that, I would probably look to rent a place in Ann Arbor, but that would certainly be a big expense. I could then come just on weekends. Not really a good situation.
 
It turns out our local center -- a major one for mid-Michigan -- has the latest and greatest equipment (Varian Trilogy RapidArc). I THINK the radiologist is very competent, although his practice is NOT limited to just PC (very few are -- I'm not even sure if the radiation guy I consulted with at Umich only does PC).
 
I did think of maybe getting the plan done at Umich. But, then again, I have reasonable confidence in the local guy. Also, one concern: isn't the plan done with their own equipment? So, does it translate perfectly with the local equipment here (with it's own calibration)? I don't know. I'm not sure if this would be a concern or not.
 
Mel
 
 

Purgatory
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Date Joined Oct 2008
Total Posts : 25380
   Posted 12/1/2010 2:10 PM (GMT -6)   
142, bb yes, your medical expenses have to exceed 7.5% of your AGI Adjusted Gross Income before you can deduct, but if you have enough medical related deductions, you can still get some tax credit.
Age: 58, 56 dx, PSA: 7/07 5.8, 10/08 16.3
3rd Biopsy: 9/08 7 of 7 Positive, 40-90%, Gleason 4+3
open RP: 11/08, on catheters for 101 days
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos marg
Incont & ED: None
Post Surgery PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, 8/6 .06 11/10 Not taking it
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, 21 Catheters, Ileal Conduit Surgery 9/23/10

BB_Fan
Veteran Member


Date Joined Jan 2010
Total Posts : 1011
   Posted 12/1/2010 3:05 PM (GMT -6)   
All, thanks for the info on tax deductions for medical expenses. I was aware that one was available, but not the specifics. I have a very thick file of receipts and should get some amount of a deduction.
 
mrbill, BB is for basketball. It's the sweet spot of the year for me now.
 
Compiler, better check with the folks at umich if you haven't already. I presumed that Dana Farber would do my SRT planning and was very surprized when they declined. I guess it would be difficult. You would have to see the planning doc weekly and coordination would be needed to tweek treatment if necessary. Also, would highten the possibility of mistakes.

compiler
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Date Joined Nov 2009
Total Posts : 7205
   Posted 12/1/2010 3:49 PM (GMT -6)   
BB:
 
I'm going to stay local totally
 
Mel

Purgatory
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Date Joined Oct 2008
Total Posts : 25380
   Posted 12/1/2010 5:02 PM (GMT -6)   
Probably a good decision, Mel. While some talk as if SRT is a walk in the park, the whole process can be very taxing
spread out over as much as 2 months. The every day, Monday through Friday routine starts to get old one you start
feeling the fatigue set in. I only had to drive 15-20 minutes each way, and even that took its toll on me.

David in SC
Age: 58, 56 dx, PSA: 7/07 5.8, 10/08 16.3
3rd Biopsy: 9/08 7 of 7 Positive, 40-90%, Gleason 4+3
open RP: 11/08, on catheters for 101 days
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos marg
Incont & ED: None
Post Surgery PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, 8/6 .06 11/10 Not taking it
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, 21 Catheters, Ileal Conduit Surgery 9/23/10

John T
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Date Joined Nov 2008
Total Posts : 4227
   Posted 12/1/2010 6:07 PM (GMT -6)   
Just like surgeons some radiologists are just better than others in planning the treatment and minimising the side affects. Again just like finding a good surgeon you have to ask around and find out who is really good. Having the latest technology is a good sign that the doctor is up to date and not cutting conners.
JT
65 years old, rising psa for 10 years from 4 to 40; 12 biopsies and MRIS all negative. Oct 2009 DXed with G6 <5%. Color Doppler biopsy found 2.5 cm G4+3. Combidex clear. Seeds and IMRT, no side affects and psa .1 at 1.5 years.

142
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Date Joined Jan 2010
Total Posts : 6949
   Posted 12/1/2010 6:41 PM (GMT -6)   
All,
 
I wonder if there is a significant value in seaching for a good RT shop based on PCa only?
 
If the equipment is up to date, and the technicians are good (and yes, who you see every day can make a huge difference), I would only be concerned that the Radiation Oncologist is good at the job. Having had my treatment at a clinic where they did a majority of PCa cases, but did a lot of other types of treatments, I was happy to see that the kids (ok, I have 25 - 30 years on them all) were more than competent at handling the changes between types of equipment set up. I felt like they understood the machine.
 
So what makes the difference? I would say that the "plan" is critical - a great staff, given a bad plan, will execute it well. I had reason to believe that my Rad. Oncologist was well focused on PCa. The technicians just made the routine not only tolerable, but precise, predictable, and almost pleasant. Meeting a smile every morning beats going to the office. And none of them handed me anything worse than a few minutes delay (ok, one day was a complete reschedule, but they called before I got out of the door). I should be so lucky every day .....

Post Edited (142) : 12/1/2010 5:45:03 PM (GMT-7)


jtouchdown
New Member


Date Joined Oct 2010
Total Posts : 9
   Posted 12/1/2010 7:20 PM (GMT -6)   
Just finished my 19th of 38 scheduled treatments today. I live in the suburbs of Philadelphia and we are pretty spoiled in this area, i.e. there are several teaching hospitals in Center City as well as a fair number of very good hospitals in the surrounding Philly 5-county area. I feel badly for you guys that are looking at a long drive each way for RT. I had at least 4 or 5 options to do my RT within a 15 minute drive of my house. I chose Paoli Hospital's cancer center because they use state-of-the-art Image-Guided RT. The way it was explained to me, every time I hit that table, the radiation is administered using a scan that amounts to a mini-MRI, to aid the beam to be as precise as possible to protect from damaging healthy tissue.

So far, so good. I am getting more and more tired but I rise at 6:30 am and I'm a late-night TV guy so that could be wearing me down. I am also experiencing an increased urgency to urinate and I am not totally voiding. Anyone else having that problem?

RP surgery in 9/09. Pre-op Gleeson of 3+3.........post-op 3+4. No lymph node involvement.
PSA of .19 in 01/10......rose to .46 in 4/10........fell to .27 in 6/10...... .28 in 8/10.......to .38 in 10/10 and 3 different Radiation oncologists recommended treatment.

142
Forum Moderator


Date Joined Jan 2010
Total Posts : 6949
   Posted 12/1/2010 7:42 PM (GMT -6)   
jtouchdown,
 
See my sig for the IGRT "journey". I started missing the 10 pm news early on. Used to be a 2 am person - that ended with IGRT. Almost 6 months out, not much improvement. The fatigue is real, and may stay with you.
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