I just drew and wrote page 40 of my cancer comic. I wanted to show the device I’m lying under 5 times a week. Does the text make sense, and more importantly, is it technically correct?
Thanks in advance.
Can someone check this?: I just drew... - Advanced Prostate...
Can someone check this?
Written by
Jpburns
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JP - I love this cartoon and this way of presenting information. And you have a fantastic style and lettering too. Never had radiation yet so can't comment on that aspect. I think a lot of aspects of prostate cancer could be communicated via this method. Interestingly in academic papers there's a whole genre of illustrations of this or that particular molecular pathway and how the therapy might impact. Often they are very complicated.
Bravo!
Looks perfect!
There's also a custom cushion filled with tiny plastic bubbles that comfortably hold your legs in place. The table is roughly aligned with the tattoos on your belly, and moved to position you within millimeters. Then the CBCT gets the position to less than a millimeter. There is also a multi-leaf collimator where the beam comes out that shapes the beam to the contours of your prostate. Of course, the beams vary in intensity (Intensity Modulated) to penetrate to the varying depth of tissue they have to penetrate through. The X-ray beams are created by an accelerated beam of 6MeV electrons hitting a tungsten target (called a linear accelerator).
All of this is pre-programmed by your team of RO, physicist, and contourist( sometimes) who go through iterations that maximize delivery to your prostate within defined dose constraints and margins) while minimizing dose to organs at risk. Your RO can show you the contour plot of the prostate, and the Dose-Volume Histogram showing the dose to the organs at risk. You may want to include those in following pages.
Thanks! I’m adding the part about the “multi-leaf collimator” because how could I resist that piece of techno-babble? Great info here. I also got the tech to confirm my verbiage. They seem bemused by my comic project.
I sort of remember that they made a custom cast to hold me in place. I did not remember the bean bag. I can no longer find thee tattoos, damn, they were expensive.
I asked for mini-skull & cross bones tattoos but the tech said little black dots were the order of the day.
Had my RT right before Christmas, but for some reason (maybe hippa) the techs wouldn't give me a copy of my pelvic region to use for my xmas card.
As a fellow IMRT patient, it was my understanding the CT part locates the gold fiducial rods inserted in the prostate.: fine-tunes beam accuracy beyond the laser tats. Other than that, great job!
Yeah, I’m EBRT, but thanks.
EBRT is the generic nomenclature for External Beam Radiation Therapy.
You are mostly getting VMAT, which is a type of IMRT. A Linac that rotates, does VMAT.
You will get a CT prior to every treatment, to properly position you, and guide the machine to properly follow the prescribed contours.
Yep. This is my second week, so get all this. I was just telling Derf4223 that I was having external, not internal radiation. But thanks. Just using the term my RO uses in his notes (EBRT) .
(Oops, just looked up IBRT. I assumed the “I” stood for “internal” (like Brachytherapy. Apparently it’s for intensity-modulated. Go figure.
Also, why does the “B” in SBRT stand for body, but in EBRT it’s for beam? Questioning minds want to know…)
Jpburns
With that type of machine, it appears you are getting SBRT, Stereotactic body radiation therapy.
You may want to mention that somewhere. Maybe it is on a different page.
Too damn many acronyms. They’re “zapping me!” Ahhh… That’s easier.
but thanks… just using the terminology my RO used in the notes.
We want you to fill a centerfold!!!😆
Me, personally? Nothing much to see there…
Jp -
They did not implant fiducials for your treatment? If not, my understanding is that they use bony and soft tissue alignment via CBCT to increase accuracy over that which might be achieved with those tattoo markers? Maybe you can ask the RO or tech for confirmation, and let us know? Some folks say that fiducials are a must for accuracy, so interested in what you were told?
I LOVE your talent....amazing!!!
No implants. Just daily CBCT before irradiation. Tall_Allen very much nailed what my treatment is in his post, above.
They did not even mention fiducials? In the Past, TA has indicated it would be almost crazy to do IMRT without them......Kaiser Doc was thumbs down on them unless doing 5 session SBRT, which was not offered to me. Did they tell you what they were using to adjust the machine each day to accomplish accurate treatment? My understanding that those tattoos are just a rough starting point...insufficient to accomplish the desired accuracy. If no fiducials, studies talk about bony and soft tissue(from CBCT) alignment.....more difficult for techs, may need RO assist?
In fact, TA's warning was so alarming that it was one reason for my delay in treatment.....looked and looked , but could find little in way of comparative studies with/without fiducials. I ended up with catheter after biopsy.....so having fiducials also worried me!!!
No, it is probably VMAT, with 26 sessions....SBRT is justs 5 or so sessions.
WRONG, you do not get 28 SBRT. It is usually 5 SBRT over a week or two weeks.
I got 20 VMAT-RT over 4 weeks. My VMAT-RT including the positioning lasted 5 minutes and I received 60 Gy (3Gy X 20fx = 60 Gy). I was also on ADT(Lupron Depot 45mg/24weeks)
That was in 2020 June.
🙉🙈🙊
Hi, love your cartoons. Here is a pic of the machine that I had 28 IMRTs last Spring
Cancer zapper
yup! 33 times VMAT, 3 SBRT , i started to fall in love with the machine seeing it daily ( except Sat and Sun) over the Christmas season.
My machine had a big smiley face on the top part, so it looked like a big cuddly Teddy bear holding its arms out to hug you. 😉👌
That was to distract you while your wallet was being emptied.
All free on Australian Medicare. 😉👌👍🙂
My copay on US Medicare $5600 dollars
So far I have paid zero. I hope the old adage of “you get what you pay for” is not true in my case.
I am sure you will do just fine! 9 months later I am still. 01 I wish you the best!
In Canada, all treatments are free and the drugs depend on your earning.
....and the NHS
I can't critique the machine rendition, but wanted to say how much I enjoyed reading your strip.
Thanks!
it looks very similar in function as the new MedBeds that are being deployed in the United States currently the only difference is your machine is using Photons the other machine in the United States uses Plasma energy for repair of the whole body it’s the new technology
Looks good to me! Just finished up 10 rounds on two vertebrae for my metastatic prostate cancer. I love your style!
Yup! looks familiar. I did 9 weeks 44 treatments of EBRT in 2019. Hats off to you JP for taking the time to get it accurate, shows you have a real talent .
Put me down for a copy of your comic JP. I love the humour. All we can safely do, is laugh at this bastard called cancer.
Hi JP, I think your drawing is great and the text is readable. The information as depicted seems fine to me, but I just rode on one, never got to drive.
Now your diagram is an excellent communication of what I will face next month with my SBRT. Thank you. I applaud your drawing skill.
It is a good thing to see this before I enter the torture salon. If I were inserted into this machine in any kind of hazy condition, I might hallucinate that I was under attack by a vicious space alien.
Haha!
I don’t know, yet, about the accuracy, JP. I’m about 9 weeks behind you. I’ll be getting the same treatment in the same locations. Hopefully, you will get through this without too much damage to the healthy cells. Wish you the best!
I was under a similar machine twice, for IMRT. 20 prostate treatments and later 30 pelvic treatments. With 28 treatments, you would be getting IMRT.
An open radiation beam is fairly wide, but with IMRT, the RO programs it to only treat the areas and organs he wants. He does this by using the initial CT simulation to program the beam to the target (using shutter colimators in the radiation head to mask unwanted areas), and the intensities, (varying the radiation at each point in the rotation of the head over your body). I.e, the intensity is lower shooting down into the prostate than it is from the sides, avoiding damage to rectum which lies under the prostate. The program is then run by the techs for each treatment, after they have used the CT head to check that the organs match the simulation.
IMRT is very useful in being able to simultaneously low-dose a wide area, and high dose a single place like a node. My second IMRT was preventive pelvic radiation, with a focus on one node.
Yeah, I just quizzed the techs, and basically, in my case:
EBRT - general name for external beam radiation therapy.
And they’re using IMRT (Intensity-Modulated Radiation Therapy) to control the levels of X-rays during the pass.
And rotating the device around me is VMAT (Volumetric Modulated Arc Therapy).
I’m not getting SBRT (Stereotactic Body Radiation Therapy), as that’s a higher dose thing.
I’m definitely doing a page or two on MAST (medical alphabet soup terms).
The RT techs love questions. For instance, I asked mine "Where is my emergency off button" (A: you don't get one. Raise your hand if you want it off.") Or "Why don't you wear dosimetry badges? (A: we leave the room whenever the beam is on.") Or "Where do the X-rays go after they leave me? (A: Don't know.) I looked that last bit up and the room has very thick lead-shielded walls and a lead-shielded swinging power door.
That is absolutely brilliant, and will help once the time comes to get under a machine like that. Great drawing.
It looks very similar to the one they used on me. It was like 6 weeks every day except weekends.
That is it. Good job!
spot on my friend. I just finished 5 weeks myself and you nailed it! Holding 32 ounces of water laying on that table wasn’t nearly as much fun as it sounds. 😟
I'd forgotten about that. Filling up the bladder "just in time" for the zapping, and being too early, or having to wait longer because of the patient before. Oh, the agony sometimes! 😳😉👍
Ai describes that type of hardware as the two armed bandit.........One arm to pull on the slot to see if you get three cherries and win a bingo teddy bear and the other one is for the doctor's to dig his robotic hand in your back pocket....
Good Luck, Good Health and Good Humor.
j-o-h-n
it’s great!
Looks great to me. And very impressed with your understanding of the machine. Ask the technicians about the beam shaping ability, how it's done, and how it's used... I think you'll be even more impressed. Ah - see TA explained it at a high level.
On that machine, if you look at where the beam comes out you can see the multi-leaf collimator and if you look each day, it's likely to be different at the start from the day before and different at the finish.
The multi-leaf collimator gives them the ability to shape the beam AS the machine rotates around you, so the maximum dose is given to the prostate with minimum damage to organs at risk. When it's spinning around you - that collimator turns parts of the beam on and parts off.
The treatment I had was IG/IMRT/Arc - meaning "image-guided" or "intensity-modulated" radiotherapy and "treated while the machine arcs around the patient and is shaped and modulated in intensity..
For a good explanation of all this stuff: floridaprostate.com/prostat...
The latest Varian machines (mine was about 6 months old when I was treated) can do this - and you don't need fiducials. The machine you show in your cartoon is identical to the one I was treated on. My radiation oncologist said having fiducials makes the techs running the machine get lazy. To treat you correctly he felt they have to be paying attention carefully and not having fiducials helped in getting them to do that.
That’s good to hear. I was afraid I was missing out on something. Plus “fiducials” sounds like something a broker would try to sell you.
Looks great!
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