Nuno Rodrigues at ESTRO 2016
At the recent ESTRO meeting Turin, one of our Radiotherapy Technicians, Nuno Rodrigues, presented the winning poster. We spoke to him about the achievement.
Nuno Rodrigues is a Radiotherapy Technician (RTT) here at the Champalimaud Clinical Centre. He has been with us since 2012 and recently he was first author on a poster for a meeting of the European SocieTy for Radiation and Oncology (ESTRO) in Turin. This is an achievement in itself, as Nuno is only 27 and leading a more experienced team at his age is quite unusual, but the story became even more amazing when the poster actually won the whole competition!
We spoke to Nuno about the poster he worked on and his work here at the Foundation.
"Good morning Nuno, and congratulations! How does it feel to present a poster as first author at just 27 years old and win?!
It was quite a surprise! This was the first time that we, as Radiotherapy Technicians, have applied to present at a European meeting, and it was completely new for me, personally. It was the first time that I have been part of a project as first author, and we were competing with other institutions with very relevant posters, too. I certainly didn’t go to Turin expecting to win, but it was a nice surprise. And it was truly a team effort, we worked really hard on this poster for a long time before I presented it at ESTRO and we are all really proud of our achievement.
Hopefully, this is the first of many things to come from us, just the first step, and this lets everybody know that we are here, we want to do things. It will motivate and encourage us to do more. It just shows the possibility of this place [the Champalimaud Foundation] to get information out there. I mean, in Portugal, we are used to breakthroughs coming from other countries, from America, the UK, the Netherlands etc., but it’s important for us to show the world that the work we do, and the way we do it, is at the cutting edge of modern medicine.
What was the driving factor behind the creation of this poster?
Here at our department, we set up different groups to work in different sub-fields. I am on the team that is dedicated to breast positioning setups. I have been working on this since we acquired a new imobilization device about four years ago. The standard setup is for the patient to lie in the dorsal position, belly-up. But for certain patients this creates concerns about the proximity of the treatment dose to the lungs, because the patient’s breast can drop over the thoracic wall, close to the lungs. We need to save the healthy tissue as much as possible, of course, so there are ways that have been studied and developed to try to do this. One of those is using a different positioning setup: with the patient lying belly-down, with the breast pending of the device, causing the mammary gland tissue that we are treating to be farther away from the lungs. In theory, this makes sense, and it is being studied extensively and proving to be successful, but there are some other factors to bear in mind. The biggest hurdle to overcome with this, is that it is not easy to reproduce this particular setup every day. There are more uncertainties, because the breast can change size or form slightly over the course of the treatment. Patients can lose or gain weight and even slight differences need to be accounted for. As long as these factors are considered and taken into account, the belly-down setup has proven to be very successful in minimizing the dose to the healthy tissue in selected cases.
This was the point of the poster – to spread the results of the research we have been doing. We wanted, not to tell others that what they are doing is wrong, or that we are right, but simply to say that we have had success with this particular way of administering treatment and it may be something that other clinics could be interested in exploring, too.
To view or download the poster, please click here.
How exactly was this research done?
We already had a database of approximately 20 patients treated with these new setup (belly-down), so we compared it with a similar sample of patients treated with a standard setup (dorsal position) to study how much shift there was between treatments (interfractional shifts); that is, how much adjustment was necessary. At the end we found that we could safely use the prone setup, while ensuring that there was no loss in accuracy.
To know how much shift we should take into consideration, we have a formula that accounts for geometric uncertainties, which was actually developed by Joep Stroom, one of the physicists that contributed to this poster. We just had to apply this formula to the new setup and in comparison to the standard positioning, we found that the belly-down treatment does give slightly more uncertainties, but this simply requires the RTTto check and correct the measured shifts every treatment, meaning that there is no real increase in the margin of error. Our correction protocol requires daily pre-treatment image acquisition, by Cone Beam Computed Tomography (CBCT).
I also have to mention that I am very fortunate to work in a place where I was allowed to do this: to be given the time to work on this; to have the opportunity to work with other, more experienced doctor’s, physicists and technicians and earn their trust to be first author on this poster."
We also spoke to Graça Coelho, Nuno’s coordinator who also worked on the poster, for her thoughts:
“We are all really excited and proud about what we have achieved together. This is a great achievement for the Champalimaud Foundation’s Radiotherapy team. And Nuno especially should be really pleased at what he has managed to do at such a young age. He’s a very talented technician with a big future ahead of him.”