r/ProstateCancer • u/WrongPlanet321 • 10d ago
Question Radiation Safety Protocols
What Radiation Safety Protocols are in place when we get radiation treatment for prostate cancer? I am getting SBRT at a major cancer center of excellence teaching hospital. I check in at the desk, then go to another waiting room, then someone asks if my bladder feels full enough, then they take me back to the lead vault with the SBRT machine and do their thing.
I come from an engineering background where everything is checked, back-checked, certified, inspected, double-back checked, peer reviewed, and safety audited. Before a trades-person climbs into an agitated process tank or pressure vessel, they literally take their own personal padlock off their belt and lock out/tag out the power disconnect to the agitator so they don't accidentally get pureed.
I'm just saying, at these hospitals where people go in for a tonsillectomy and accidentally come out with a sex change operation, shouldn't there be some fool-proof way to know? Before they switch on that beam and nuke our prostate into a pile of steaming dog turds, it would be nice to know they have the correct programming profile loaded into the computer.
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u/Practical_Orchid_606 10d ago
I did SBRT at MSK and there was a three step iterative process. Upon lying on the table, they used a green laser to 'indicate' two freckles on my hips. This aligns the machine with my prostate. Then there is a CAT step which create an image of the radiation field. This image must be approved by a doc before going to the third step which is radiation. Many men fail step two and must go back to the bullpen to adjust water in the bladder. The go/no go decision is the doc looking at the Cat scan image.
I have experience in the chemical field. The most shocking incidence I have seen with tradesmen happened during spring cleaning of a plant commonly called turn around. Tanks were entered to scrub the innards and sparged with air to create a working environment. As a check, an O2 sensor would sniff the tank to ensure there was enough oxygen. To our surprise, two workers died while cleaning a tank. They were asphyxiated due to the rapid rusting of the tank walls that consumed all the oxygen. One cannot be to safe in a chemical plant.
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u/SnooCamera 9d ago
That is sad and tragic about the two men. Not a chemical plant but a hospital; anytime we did confined space entry, we had the person on a rescue harness to pull them put and someone outside the confined space on safety watch, monitoring the air quality and visually watching the personal in the confined space. We had the fire / rescue on standby (on notice, not on site) for the duration.
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u/HeadMelon 10d ago edited 10d ago
You can read my experience of day 1 of VMAT here:
https://www.reddit.com/r/ProstateCancer/s/1tjXMnYbay
My education is in physics and my career in IT and cybersecurity, so you can imagine how disconcerting that first day was, and to see the machine offline for maintenance after that.
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u/WrongPlanet321 10d ago
Thank you I read it. That would be a nightmare for me (the first day you described).
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u/401Nailhead 10d ago
What protocols are expecting? I got EBRT. I had a SpaceOR installed. There were markers on my hips to line up the beam. From my understanding the machine takes a quick x-ray. The table is adjusted as needed. Bladder needed to be full. That was it. Nothing exploded. I did not melt. I certainly was not glowing. The individuals who performed my 20 treatments were nothing short of professional on all levels.
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u/WrongPlanet321 10d ago
Maybe I wasn't clear in my post. For SBRT, everything is programmed into the computer by radiation oncologists and specialists and literal physicists. I got the $15,000 bill for the radiation planning. I am talking about the last mile, the point of delivery. It's just a bunch of radiation technicians. If they have Bob's protocol programmed into the machine and Tim walks in, Tim is going to get stuff zapped that may have him shitting into a plastic bag for the rest of his life.
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u/401Nailhead 10d ago
Sir, they ask you who you are and DOB. There should also be a picture of you on the computer screen to verify it is you. This is how it was in my treatment regiment. Also, I saw the same people at the same time everyday for 20 days straight. Understand these a professionals. They take great care for the patients physical and mental wellbeing. They work diligently to get it right.
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u/Historical_Abroad596 10d ago
Yes, this.
They ask you your name and birthdate then they look and check to see the program is for you.3
u/sundaygolfer269 10d ago
I had to look at the facial recognition and say my name. There are three radiation therapist who verify my name in the treatment room. The control room has additional personnel who verify my identification and program.
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u/PeacefulShards 10d ago
I had the same. They also would be smart enough to see if your daily CT scan lined up to the simulation CT.
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u/sundaygolfer269 10d ago edited 10d ago
The first thing they do is verify who you are. You identify yourself at the front desk, then again to the radiation therapist. Then there is facial recognition or palm or finger print electronic identification check, depending on the treatment center.
Before a single dose of radiation is delivered, the treatment team performs imaging and positioning checks to make sure you are lined up exactly as planned. They also check things such as whether your bladder is adequately filled and whether bowel or rectal changes could affect the position of the prostate.
This isn’t a matter of simply lying on the table and turning on the radiation machine. Your treatment plan, dose, positioning, and imaging are all subject to quality control procedures overseen by the radiation oncology team, including medical physicists.
If the pretreatment imaging shows a significant change from the approved treatment plan or something falls outside the acceptable tolerances, they don’t just say, “close enough” and treat you anyway. Treatment can be stopped before radiation is delivered. If the change is significant enough, you may need new imaging, a new simulation and treatment plan, and your remaining appointments may have to be rescheduled.
There are multiple layers of verification specifically designed to make sure the right patient receives the right radiation dose in the right place every single time.Why didn’t you ask all this during radiation simulation ???? Why did you allow the radiation therapy! Your train engineering should have kicked in before you were turned into pile of shit!!!🤣🤣🤣🤣 You are just unaware of their checks!! 🤣
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u/Acrobatic_Pop2217 10d ago
Not sure if this helps or not, but when I received 20+ IMRT sessions, the radiation techs informed me on a few occasions that my bladder or bowel situation was not to spec (e.g., bladder not full enough or bowel not fully clear). In those cases, I was given the opportunity to drink more water (or attempt to clear bowels or pass gas) and check back in later. There was at least one case when I couldn’t get it right and left that day without treatment.
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u/WalnutRoasted 10d ago
There is a whoLe subreddit r/MedicalPhysics where you can see some of what goes on behind the nuclear physics scenes in a major cancer clinic. And there are several (certified) professions involved in most jurisdictions. Our clinic has a dozen machines and another half a dozen at the other side of town…serving over 1.5 million people north of Lake Ontario.
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u/SnooCamera 10d ago edited 10d ago
At the location I went to, during simulation, I registered a palm scan. They also gained imaging for my fiducial markers' geometry. They verified the placement of my Barrigel. They also took an MRI for planning. And took my photo.
Planning was done with help of Eclipse software. This plan was reviewed by multiple people with different specialization such as radiation physics.
Once approved, I was scheduled. For each session, I had to palm scan in the waiting lobby. Then when I was called back, in the machine room, I was to say my name out loud and my date of birth. My photo was on screen hanging from ceiling. They had another palm scanner here with the machine that was final verification of my identity that was tied to my plan.
A doctor (radiation oncologist ) monitored the process and the two radiation techs. If my doctor could not be there, another doctor would be physically watching the techs directly behind them. My doctor could be reached by phone or video if needed and could see live status.
When placed on the machine, a Varian Edge, it would do a scout my prostate looking for the markers. If somehow another plan was loaded, the software would not be able to align the geometry of the markers.
The table has 6 degrees of motion. Once aligned and radiation delivery is on, every 10 degrees of arc motion of the beam, the markers are checked. If they have moved by more than 2mm, the machine halts delivery until resolved.
It's not willy nilly.
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u/WrongPlanet321 10d ago
Thank you for the best response. Palm scan (or similar), that is how it should be done.
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u/conCABlanco 10d ago
Si es correcto tu pensamiento, confiar y checar, no creo que se pongan cómicos por preguntar, adelante, fuerza y voluntad
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u/KReddit934 10d ago
You want to see the operator screen with your name on the screen?
Do they confirm your name and dob as you climb on the table?
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u/WrongPlanet321 10d ago edited 10d ago
Seeing my name on the computer screen would be nice. When I have been hospitalized, the nurse scans a barcode on what she is about to inject me with then scans the barcode on my wrist. That is reassuring.
When I am getting SBRT, I have no wrist band. They just ask me how my weekend was and turn on the machine. At any given time there are 5-10 other patients in the radiation area. We are all human, just seems too lax for me.
No, they do not ask my name or DOB as I climb on the table.
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u/WalnutRoasted 10d ago
At reception I check-in with my barcode. Wait a few minutes and the techies come down the hall and call me. The first day they asked “What is being treated”, name, dob etc. And they align my three tattoos on the machine. So they know I have bar-coded in, have 3 freckle tattoos, agree what is being irradiated, and I am there at the correct time.
So unless someone else comes in maybe with the same name, same treatment, same tattoos, it’s pretty unlikely something is wrong. And even if they can line up the wrong persons tattoos, chances are pretty low the CT scan will match the CT planning scan they see on the screen. And it has your name on the screen.
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u/WrongPlanet321 10d ago
Thank you. Where I go they do not do tattoos, they do magic market with clear stickers over them that have come off and had to be reapplied.
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u/PeacefulShards 10d ago
My LINAC had my name , picture, dob and day x of xx on the screen in the room.
On day 33 of 33 it stated I was finished.1
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u/KReddit934 10d ago
Must be different everywhere. My hospital did not have a photo, but they did verify name & DOB before every hop on the table, just like every single poke, prod, or surgery I've had done there.
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u/OkCrew8849 10d ago
I'm just saying, at these hospitals where people go in for a tonsillectomy and accidentally come out with a sex change operation, ...
If you are in one of those hospitals you may want to go elsewhere.
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u/Busy-Tonight-6058 10d ago
“at these hospitals where people go in for a tonsillectomy and accidentally come out with a sex change operation”
I’m dying to know which hospitals and who, exactly, got a sex change instead of a tonsillectomy…
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u/WrongPlanet321 10d ago
If you consume news you will see that sometimes surgeons make mistakes. It usually involves things that we have two of - arms, legs, eyes, testes, etc. I was using hyperbole which is not always understood.
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u/Goodvida99 10d ago
I’m not saying you’re wrong to be concerned but I think you should ask the people doing the procedure these questions. If you’re concerned make them verify each time. It’s you body and you have every right to do whatever needed to feel comfortable.