Erin Murdoch

Clinical Practicum II

Service Learning Journal – Employer

The department where I am completing my clinical practicum is the Massey Cancer

Center of Virginia Commonwealth University (VCU). Because VCU is an academic hospital,
there are many other students in my department and educational opportunities are frequent. Some
of the other students include residents, medical students, physics students, and radiation therapy
students. I completed my undergraduate degree with VCU’s Radiation Therapy program in the
Department of Radiation Sciences. I reached out to the therapy professors for ideas on a
volunteer project that benefited VCU. My professors had recently gotten a Virtual Environment
for Radiation Therapy (VERT) lab in their new department. The VERT system allows the
therapy students to practice patient set up on various machines. It also enables users to import
completed treatment plans, so students can see how dose distributes in a 3D view. My professors
requested that I compile a list of patients who were previously treated at VCU that correspond
with the therapy curriculum. They also suggested I create a case study to present to the radiation
therapy seniors when they return for their fall semester.

I compiled a list of 40 patients who were treated at VCU to be anonymized and imported
into the VERT system at the educational department. The VCU therapy program divides
curriculum by treatment site rather than generalized location (Ex. Prostate, not pelvis), so the
most time consuming aspect of this project was double-checking each patient’s diagnosis to
ensure I covered each chapter. Additionally, I created multiple plans for some of the patients that
conveyed different treatment techniques. This will enable students to compare 3D, static IMRT,
and VMAT techniques implemented on the same patient. Because I completed the program in
2018, I was able to include visualizations for concepts that I struggled with as a student. I also
reached out to my old classmates who shared their perspective on what would have been most
helpful to see. One example I included is a breast patient with two separate tangent plans, one
half-beam-blocked with the isocenter in the patient lung, and one with isocenter in the breast
tissue and gantry angle divergence matched. I also included two examples of total CNS
treatments, one on a younger child that only required one spine field, and one on a larger patient
who needed two separate spine fields. I also selected a breast patient who had large expanders
following a double mastectomy, because it will help explain why it is beneficial for contralateral
expanders to be deflated for treatment. Images of treatments shown on the VERT system are
attached below.

The case study presentation that I put together features a head/neck patient that I planned
last month. The patient’s primary was oropharyngeal, and he had a pacemaker within a
reasonable distance from his treatment site. I spent a lot of time planning this patient and I had to
create both a static IMRT and VMAT plan to compare PTV coverage vs pacemaker dose. It was
also the first time that I really participated in the process of monitoring pacemaker dose with
OSLDs and sparing techniques. The normal tissue sparing and target coverage was similar
between the two plans, and the pacemaker dose was only slightly higher in the VMAT plan. The
planning process was a learning experience for me about why we protect pacemakers, and how
these devices are impacted even when they are far from the treatment site. I think the most
beneficial part of my presentation is the connections I make to my experience in therapy clinical
rotations, and aspects of treatment that I was familiar with but only fully understood after
spending time in dosimetry. I included pdfs of my presentation below, and I will present the
PowerPoint to the senior class on August 20th.