Biomedical Engineering Reference
In-Depth Information
risk-taker and opt for an aggressive treatment, or may prefer a more
conservative approach. And, he or she may be particularly interested
in avoiding specific morbidities. These considerations are certainly in
the clinician's mind in formulating the planning goals, but I believe
the patient needs to be brought into the decision-making process more
often and more explicitly than is the custom.
The patient as monitor of the treatment
Experienced therapists have often had the experience of patients
reporting unusual events during their treatments Seemingly minor
observations (unusual noises, unusual session duration, bodily
reactions, etc.) may be harbingers of danger.
I had an experience, very early on in my career in radiation therapy,
that has stayed vividly in my mind. I was responsible for planning a
treatment for a patient for whom I had designed and laboriously hand-
made a compensating filter (see Chapter 4). The patient had a pelvic
tumor with a sloping lower torso and the compensator was designed
to deliver a uniform dose at the depth of
the tumor. The treatment machine was a
ceiling-mounted 2 MeV van der Graaf
accelerator whose beam was pointed
downwards at the patient, lying on a
couch. After the his first treatment
session, I was informed that the patient
wanted to talk with the person who was
responsible for the technical details of his
treatment. Assuming he wanted to
congratulate me on my fine work, I
hurried round to see him. “As I lie down
on the couch” said he, “I can see the
gadget that you made for me, hanging
below the machine. Doesn't that mean
that scattered radiation from it is reaching
my eyes? What is the dose to my lens?”
Figure 8.11. Schematic
view of a patient beneath
a treatment machine. The
patient could see the com-
pensating
filter,
from
which he deduced that
scattered radiation could
reach his eyes.
(See Figure 8.11). I was enormously
impressed by his acute observation and
common-sense. I had no idea what the
answer was, and spent that evening measuring the scattered dose -
which turned out to be acceptably low, but by no means negligible.
From that day on I have regarded patients as technical partners in my
work.
