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Clinical Topic (OSU BLOG) Entry #4 – Ryan Leo & Matt Lin

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Name(s): Ryan Leo & Matt Lin

Date: 4/6/2023

Preceptor: Dr. Sachin Jhawar

On Thursday, March 23, we met with Eric Cochran who is a lead medical physicist that works directly on projects with Dr. Jhawar to make sure the radiation processes are working effectively. We met with him to go over the rest of the project and he gave us many of the issues that we could run into when completing the project design. One of the main issues for modeling the project would be to get the many measurements needed to create an improvement to the already-created board. To solve this issue, he worked alongside the CT simulation team to scan the board that patients lay on and completed contouring that could be converted to a 3D model in any software we would like to use.

On Friday, March 31, we went into the clinic and reserved the conference room to work on modeling the project, but also being able to ask questions or take measurements whenever needed. To start, we took the scans from Eric Cochran which were in the file DICOM. Based on this file type, we looked up various methods online that could convert a DICOM file type to an .stl file type which can be read by the 3D modeling software we decided to use. The methods found online all pointed us to use the program known as 3D Slicer which is a free software that can load DICOM files and convert to various different models. Once loading the DICOM into the 3D Slicer, we were able to convert the 3D model of the board to an .stl file. We then decided to use Fusion 360 as our 3D modeling software because it is free for students, allows for real-time collaboration and can load .stl files. We loaded the .stl file of the board, and then began modeling our improvements of the board right on top of the 3D scan.

We ended up creating a two-part improvement to the board that can act as a riser on top of the board to relieve pressure on the stomach. There is a main piece, labeled as “Part A” which will act as a piece that will not change and “Part B” which can be changed out next to Part A based on the size of the patient. So far, we have created only two different iterations of Part B, Part BL (long) and BS (short), but more iterations can be made to match more and more sizes of patients. These two B parts have a length difference of 50 mm to match a shorter or taller patient. The dimensions of Part A is 480 mm x 690 mm x 35 mm and Part BL is 480 mm x 450 (400 for BS) mm x 35 mm. These dimensions came from the current pad that is used as the solution to the stomach pressure problem.

 

360 board that the parts could be added on top of to improve the prone breast radiation or CT simulation.

The original belly board with the two different parts added on top. (Part A to the left and Part BL to the right)

 

Clinical Topic (OSU BLOG) Entry #3 – Ryan Leo & Matt Lin

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Name(s): Ryan Leo & Matt Lin

Date: 3/23/2023

Preceptor: Dr. Sachin Jhawar

Over the past month, we have become more immersed in the radiation oncology processes and were able to work with the lead CT therapist at the clinic and the physics and dosimetry teams. On Thursday, March 2nd, we worked with Tina LaPaglia, the lead CT therapist at the clinic. She gave a full demonstration on how CT simulation is completed in radiation oncology and was giving both of us the many bottlenecks that she runs into during her daily processes. CT simulation is a complex process that varies between every patient based on their medical needs and body size. Some of the techniques used during simulation are immobilization using a Vac-Lok and tattooing a patient to create an accurate way of administering radiation treatment. 

We were all bouncing ideas off of each other mainly in the field of reproducibility and comfort of patients during prone or supine CT simulation. Between prone and supine treatments, there are disadvantages. For supine patients, they are asked to hold their breath (to elevate the breasts away from chest cavity organs) to minimize radiation exposure. The problems mainly reside in inaccuracies and inconsistencies in applying such treatment. For prone patients, we face the issue of creating a comfortable environment for heavyset patients with larger stomachs. Previous patients have reported they had trouble breathing which is not ideal. Between supine and prone patients, different boards and set-ups must be interchanged for the treatment. Tina communicated to us that it was troublesome and difficult to be accurate during patient revisits as the setup is inconsistent issues in front of us gave us a better understanding of how we can work on developing and modeling innovations to accommodate patient comfort and accurate treatments. We communicated to Dr. Jhawar that we are interested in producing a new belly board that can improve comfort and reproducibility during therapy.

On Thursday, March 9th, we were able to work with the dosimetry and physics team. Working with the dosimetry team, we learned how they plan treatments. At this point, Dr. Jhawar communicated to his team that we were interested in modeling a new belly board for prone patients. We were given an in-depth view of how they contour the breast, especially for prone patients who might have larger breasts. We also learned about the guidelines about how much radiation can be exposed to specific parts of the breasts and chest cavity. Working with the physics team, we talked about developing the new belly board. Ryan brought up the idea of using a trampoline-like material to support the underside of patients that can provide a custom sha, providing a custom shape andup the idea of a table that is segmented into parts and can be modified on the spot to accommodate both supine and prone patients. Eric, the lead physicist, brought up a new idea that was much simpler than creating a new belly board involving the elevation of the legs. Making us aware of FDA guidelines and our time constraint, this new plan seems much more feasible. He also proposed a possible software project which has been deemed as too complex. 

On Tuesday, March 21st, plans were finalized, and we will be scanning the prototype boards to start the project on Thursday, March 23rd.

Clinical Topic (OSU BLOG) Entry #2 – Ryan Leo & Matt Lin

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Name(s): Ryan Leo & Matt Lin

Date: 3/1/2023

Preceptor: Dr. Sachin Jhawar

The past two weeks have been very involved in understanding the basics behind radiation oncology. Last Tuesday, February 21st, we gained a clinical perspective of radiation oncology. Following Dr. Jhawar, we met his staff and looked at patient data as he prepared for his first consultation. 

Upon patient consent, we followed one of the physician associates into the examination room. Once there, we gained an understanding of patient-healthcare professional interactions. The physician associate provided a comfortable environment and asked questions about carcinogenic history, past radiation oncology treatments, etc. Additionally, the use of birth control pills or alcohol consumption were two aspects of the questionnaire that required much precision to be answered by the patient. We were then asked to leave the room for the patient’s physical examination. At this point, we reconvened with Dr. Jhawar who gave us a brief insight into how we can treat patients with radiation. One way is through a supine position; the other is the prone position, which is a new way of treatment. The entire goal of radiation oncology is to provide radiation treatment to the affected site while minimizing radiation to neighboring organs. Dr. Jhawar informed us that the prone position is an excellent way of treating the breast. Even though the heart lies against the chest cavity, there is much more minimal radiation exposure to the rest of the body than compared to supine. Generally, mastectomy patients will receive radiation in the supine position due to metastasis, but almost all patients with lumpectomy receive prone radiation if they are physically capable.

On Thursday, February 23rd, we worked with the therapy team and witnessed patients receiving their radiation treatment. The basics behind receiving treatment first involved the patient undergoing a CT scan. Once the scans had been processed, the patients were moved to the linear accelerator, a device used for external radiation treatments. They were asked to lie down on the table supine. A breath holder device was placed on the patient; this device is tracked by cameras to simulate the patient’s respiration pattern to aid in radiation treatment and minimize radiation exposure to other parts of the body such as the vital organs in the chest cavity. The patient was asked to hold their breath and during that time radiation was applied. 

On Tuesday, February 28th, Dr. Jhawar demonstrated how he reviews radiation plans created after the CT simulation. He showed us how to contour various parts to outline the tissue receiving radiation and the computer software he uses that outputs warnings if radiation exposure does not fall within tolerance. Along with this software, he explained to us that his goal in research is to develop better machine learning that can contour and verify CT simulation. Machine learning will save time so physicians can meet with patients longer, rather than sitting in their offices looking at plans.

 

Clinical Topic (OSU BLOG) Entry #1 – Ryan Leo & Matt Lin

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Name(s): Ryan Leo & Matt Lin

Date: 2/13/2023

Preceptor: Dr. Sachin Jhawar

For the clinical preceptorship, we were paired with Dr. Sachin Jhawar. Dr. Jhawar is a physician specializing in radiation oncology and treats many patients at the Stefanie Spielman Comprehensive Breast Center. He works alongside roughly 40 other members at the breast center with backgrounds in physics, physical therapy, and computer science.

So far, we have had two meetings with Dr. Jhawar and were given a brief tour and introduction to the breast center. During the tour, we saw the many rooms and offices of the building and saw some of the equipment used for radiation therapy. Next week, we will begin shadowing Dr. Jhawar while he completes clinical procedures, and we will also begin brainstorming ideas for a project that we will work on for the semester. We will also work closely with Dr. Jhawar’s team, and for whatever the project calls for, we will work with a member of his team with that area of expertise.

Additionally, Dr. Jhawar provided multiple resources to us to learn more about radiation oncology in terms of videos and papers written for medical students. In these resources, the science behind radiation therapy is discussed and the step-by-step process for the procedure on patients is described. An intriguing topic in one video was the use of devices to immobilize patients so that radiation therapy is comfortable for long periods of time and repeatable. We asked Dr. Jhawar about working on a project in this field, in which we would work on developing a new kind of immobilization device. He said that one of his team members would gladly work with us, but an immobilization device is just one example of a project we could work on. Dr. Jhawar further talked about how he not only wanted to treat the symptoms of his patients but also the convenience of them. The problem with a lot of these available treatments is that they are time-consuming, and patients have to regularly come in, especially if receiving palliative care. We also started brainstorming a couple of ideas on this topic and will find out about the project we are working on in the upcoming weeks.