HJNO Jul/Aug 2021

INSIDE LOUISIANA’S WAR ON CANCER 28 JUL / AUG 2021 I  HEALTHCARE JOURNAL OF NEW ORLEANS developments that are ongoing and grow- ing, but those continue to be the three major pillars of cancer care. Radiation is powerful, because it brings together the best of both worlds between surgery and chemotherapy. Surgery is great, because you can physically remove cancer tissue, but you can’t do it everywhere because you can’t get to every- where. And, not all patients are candidates for surgery. Chemotherapy is very effective because it is systemic — it reaches all parts of the body — so it’s very effective at getting to those areas of the body where we may not even know that cancer exists. Radiation is a great compromise between those two, because we can target it. It’s not as systemic as chemotherapy is, but we can also reach areas of the body that surgery cannot get to. The downside, of course, as you mentioned, is that there is the risk of side effects associated with radiation ther- apy, and the type of side effect that some- body might experience depends on their type of cancer and how that cancer is going to be treated with radiation. We’ve seen a tremendous amount of progress within radiation therapy in reduc- ing side effects over the last probably 10 or so years by utilizing imaging more heavily to target our radiation beams. Today, when a patient is treated with cancer, we utilize three-dimensional imaging to be able to visualize, to see the location of, the tumor and the location of the critical structures that we’re trying to avoid before each treat- ment. We can see that better before each treatment; we can aim our treatment fields more accurately. We’ve been able to reduce the amount of healthy tissue that we have to treat through during a course of radia- tion therapy. The next big thing that is coming is going to be another paradigm shift that is also dependent upon better use of imag- ing before treatment: the use of imaging to not only tell us where to direct or point our radiation beams, but also to change the treatment plan entirely on the fly each and every day. That paradigm is called adaptive radiation therapy. What adaptive radiation therapy is, is not only placing the radiation fields in accordance with where the tumor is but changing them to take advantage of any advantageous movement of the criti- cal organs around the tumor that gives us a better window to be able to treat the cancer. Editor That makes sense. Is it happening now? You said it was futuristic. Fontenot We are in the process now of plan- ning for an adaptive radiation therapy pro- gram. It’s not operational presently. There’re only a handful of academic centers around the U.S. that have incorporated this tech- nology in the last year or two, but it’s on our roadmap, and we expect to be able to fur- nish this type of program in the very near future. Editor There are concerns for healthcare workers being exposed to long-term low levels of radiation from medical equipment, even with the proper safety procedures or measures in place. Do you think these con- cerns are valid, and do you see a solution? Fontenot They’re valid. Anybody who works in or around ionizing radiation (when I say that, I don’t mean ultrasound or other types of equipment that use electromagnetic radi- ation — that’s different from x-rays, which is what we use to treat cancer) has a rea- sonable and legitimate concern about their safety. But that’s why, at a national level, entities like the NCRP exist — the National Council on Radiation Protection. These national bodies have spent an enormous amount of time putting together a set of guidelines that provide very conservative limits upon which staff radiation workers can be exposed to on an annual basis. Let’s start with the fact that we’re all exposed to radiation every year, even just by living on this earth. It’s in the rocks. It’s in the soil. It’s coming from space. There’s a low-level amount of it that we’re all exposed to on a day-to-day basis, so you can’t limit it to zero because we’re already being exposed to it every day. What there are, though, are slightly ele- vated limits that the regulatory agencies that exist in the U.S. and in the state of Louisiana insist that radiation workers must be lim- ited too, and we have a dedicated radiation safety program across our enterprise, which ensures that everyone who is or may be in contact with ionizing radiation has radiation dosimeters on them at all times through- out the day that are read weekly, monthly, that are changed on a periodic basis, and that are inventoried and categorized on an ongoing basis. We have a team in our radiation safety office whose primary job is to make sure that we’re monitoring our staff appropri- ately and that our staff do not exceed the minimum levels that are set forth by our regulators. It’s a heavily regulated space. The limits that are in place now are incred- ibly conservative, and I have no concerns whatsoever that anyone within our pro- grams or anyone who’s adhering to those NCRP guidelines is placing themselves or their staff at any excess risk. Editor What do you call the device that staff wear? Fontenot It’s a radiation badge; there’re actu- ally a couple. There’s a small film badge that people wear on their chest on the outside of their lab coats, and then there’s also a ring badge. We’re interested not only in moni- toring radiation exposure to your trunk, but we’re also interested inmonitoring radiation exposure to your extremities, so we have a couple of different ways of monitoring dose for our staff. Editor Is there a special type of person that is attracted to oncology? Fontenot Yeah, I think it takes a different type of person, a different type of mindset, to want to work with chronically ill peo- ple. Interestingly enough, one thing that most people don’t necessarily understand or appreciate for radiation oncology, and I think this is probably true to some extent for