Techniques..

Explaining the techniques used in ORCI will not take me long as they are very basic and all very much the same. Not because they know no different, because they all get taught the same things as us (but their knowledge is just all theoretical rather than practical), but their techniques are the way they are because of the equipment that they have sadly. 

As there sinulator is a bit tempormental and most techniques are just done by the book and with surface markings, after a few days picking the set-up was easy. 

For cervical cancer - most of what I see - they are mostly late stage and the technique used is SSD100 (or SSD80 if you're on the other machine) and a field arrangement of anterior and posterior parallel opposed pair. Field sizes have to be large to encompass the large extent of disease (which you can often see bulging and can smell from a distance sadly for these women). The general field size is 15 x 15cm, which is sometimes coned down to 10 x 10cm or 12 x 12cm after their initial 25 fractions and review by their doctor. As these patients don't have marks on their skin, surface anatomy is used to position the field. The lower border is the anterior commissure and the upper is just below the umbilicus, to position the lateral borders the Sagittal laser is positioned running through the middle of the vulva. 

For almost every head and neck cancer right and left parallel opposed fields are used. The field size for these is not as predictable and will vary depending on the extent of the disease and where exactly it is obviously. Some may be 8 x 5cm for example, while others 12 x 10cm. The decision on field size is made by the radiographer a treating the patient on the first day and their knowledge on the cancer and patient; so this can be very subjective. But their textbook knowledge is very good so they know how it should be. 

Some lymphomas of the head and neck and other more superficial cancers are treated with direct single anterior or posterior fields - also varying in size depending on the tumour. 

As you can see, the techniques are very much palliative in their style and although the majority of patients are very late stage it is not ideal. But Asides from these three techniques anything else is very much impossible due to their lack of equipment and money and the fragility of the equipment; I have been told by one that they don't like moving the jaws of the machine too much as it makes it very tempormental, like i wrote in my last post. They would all love to be able to move on to greatest things, but right now they are doing the best they can for their patients. 

Their technique for breast is however nearly identical to our technical, the only difference being that they used an SSD of 100 as they don't have the facilities for planning obviously. So the standard treatment is medial and lateral tangentials; they were surprised when I said we were doing the same in the UK! They even use half beam blocking for the medial border, but not for the superior border of the field where it mets the supraclavicular field. There is a difference with the patients too. Because the majority are caught late stage this means they have all had mastectomies, I don't think I have seen one patient without one. As this is the case, it also means that they all have supraclavicular fields too - with the exception of one patient I have seen.