I understand the treatment of disease part, but I’m lost at the x-ray and radioactive substances part. But wait! Haven’t we been told our whole lives to stay away from radiation? 3-Mile Island, Chernobyl, Fukushima? And the signs: “DANGER Radiation Risk”? Despite this, our patients come each and every day for radiation treatment. They put their trust in the hands of the physicians, physicists, dosimetrists and radiation therapists. They don a gown, lay down and stay still while a machine whirs and moves around them and delivers high doses of invisible radiation.

Because of what I know about the technology of radiation therapy and the quality measures behind the scenes, it is easy for me to reassure patients who may present with concerns. As a radiation oncology social worker, I need to be educated about the treatments that patients receive so I can help to educate them. I often find that when patients score high on the distress thermometer before starting treatment, their main cause of anxiety is not knowing what to expect once radiation begins. By verbally walking them through the process, their anxiety is reduced and the first day often goes much more smoothly for both patient and the treatment team.
    
One of the things I love the most about my job is that even after more than 10 years in radiation oncology, I still learn something new about the treatment process every week. Although much of what is done behind the scenes in the treatment planning phase is more complex than I could ever hope to fully understand, I am equally amazed by both the high- and low-tech methods that are used in treatment. In honor of the recent National Radiologic Technology Week (NRTW), and to share a glimpse of the some of the methods used by radiation therapists to assure that our patients are kept safe, I want to share some of the low- tech methods that I am better able to understand.
 

• Face photo is one method used for quality assurance. Because patients come from home to treatment for up to seven weeks at a time, we choose not to require them to wear a hospital wristband. As the wristband is the standard method for patient identification in a hospital setting, the radiation center needs to employ an alternative. Patient identification is achieved by taking a face photo, which is digitally loaded into the electronic medical record. Each day, the patient is asked to identify their own photo, along with stating their name, birth date and body location of treatment. The therapists explain to patients that it is not that they don’t remember them day to day, but that this quality check is one way to assure that they treat the right patient at the right site every time.
   
• Tattooing is a second low-tech method. Yes, patients are given real, permanent, ink tattoos on their bodies (typically on the torso or pelvic area, depending on location of treatment). The tattoo is barely noticeable, about the size of a small freckle. Because of the length of treatment, it is not practical to mark patients with tape or permanent marker as these methods would not last. The tattoo provides a reliable mark for therapists to ensure an accurate target.
   
• Deep Inspiratory Breath Hold (DIBH) is perhaps my favorite low- tech method used in radiation treatment. It is used for some left-sided breast cancer treatment and involves the participation of the patient by holding their breath for a few moments each time the radiation beam delivers treatment. The purpose of the deep inspiration is to move the heart down and back, away from the radiotherapy field. For some patients, the use of DIBH provides excellent heart sparing as compared to free breathing.

Of course, no amount of technology, low-or high-tech, could ever keep patients truly safe without the skilled and caring professionals who plan and administer radiation treatment. Whether on the front line of patient care, or in a dark back office filled with computer screens, it takes a special person to work in oncology. If you have a minute, be sure to thank a radiation therapist today!