Delivery of Radiation in the Past and Today<\/strong><\/p>\n\n\n\nUp until the 2000s, radiation therapists had to select every single field directly at the linear accelerator. In addtion, they had to place so-called blocks made of lead in the shape of the target volume in the beam path correctly to protect the healthy tissue. <\/p>\n\n\n\n
Today, in contrast, the entire treatment with all its fields is delivered automatically, using the thin lead leaves located in the treatment device itsself to form the shapes of the target volume. A session can take up to then minutes, depending on the complexity of the radiotherapy plan. The automation saves the radidation therapists much work, many walks into the treatment room, and having to lift the heavy lead blocks.<\/p>\n\n\n\n
Mistakes can be made using either method. Directly at the linear accelerator, therapists may shape a treatment field incorrectly. When the treatment plan is entered into the software, which controls the linear accelerator, wrong values regarding a certain field, or an entirely wrong treatment plan might be input. This can happen especially when a patient has two treatment plans, where the fields are diminished in the second one.<\/p>\n\n\n\n
Looking at the Patient Carefully<\/strong><\/p>\n\n\n\nIn the past, radiation therapists entered the room to configure every single treatment field, which was also an opportunity to look after the patient at the same time. Today, the patient is alone during the whole application of the treatment and only monitored using video cameras. <\/p>\n\n\n\n
It can be observed that monitoring the patient is sometimes neglected. This can be fatal as not all patients manage to lie still. However, if the patient feels unwell all of a sudden, this should be noticed at once, as should be any movement.<\/p>\n\n\n\n
The Effect of Automation on Our Knowledge<\/strong><\/p>\n\n\n\nIn the past, all aspiring radiation oncologists and radiation therapists knew why the treatment fields are shaped in what fashion. Moreover, they could visualise the fields including the blocks three-dimensionally. Such knowledge falls behind today, as everything is done by the computer anyway. <\/p>\n\n\n\n
It is essential for good treatment planning and delivery, which also includes to ensure that the fields are applied precisely in relation to the body, to fully comprehend the geometry and physics.<\/p>\n\n\n\n
5.2. The Patient Is Being Monitored<\/h3>\n\n\n\n
Not as intensively as during general anaesthesia, a patient is also monitored in the ambulance with respect to certain vital signs, such as blood pressure, heart rate, and oxygen saturation in the blood. This, of course, is very handy, but also relevant. <\/p>\n\n\n\n
However, it is important now to look at the values actively, to draw conclusions, and to detect any changes early. In addition, it is vital to correlate the values with the patient\u00b4s clinical presentation. Why does the oxygen saturation suddenly drop?<\/p>\n\n\n\n
There are many reasons for that, ranging from a real decrease, to the blood pressure being taken on the same arm on which the fingerclip to monitor the oxygen saturation is applied, and technical failures. Whereas young emergency technicians sometimes concentrate on the displayed value only, one should first of all look at the patient and check whether, for instance, his or her breathing has deteriorated.<\/p>\n\n\n\n
5.3. Despite Technical Examinations, We May Not Unlearn the Anamnesis and Physical Examination<\/h3>\n\n\n\n
Today, it is still about the patient as a human being, with whom we speak first. Through a good anamnesis, we can already make 80% of the diagnoses, or at least establsih a working diagnosis. We should not unlearn excellent physical examination techniques and correlate the results with our anamnesis. <\/p>\n\n\n\n
Only then we should consider necessary technical examinations, which, ordered only when really needed and with the correct question to be answered, add considerable value today. With the results of such examinations, and in the light of the anamnesis and the physical exam, we will discuss the treatment options with our patient.<\/p>\n\n\n\n