My Project Gallery Revolution (Part 3)

This is the third posting in a series describing my experiment on creating a project gallery at the Canadian Organization of Medical Physics 2015 Winter School. See Part 1 and Part 2 for entries.

Now to get down to business. The fundamental things I would like to have in the presentation include:

• Data
• Graphs of retrospective audits of patient shift data from our older experience with MV imaging, contrasted with similar graphs of audits from the new kv orthogonal imaging. This is pretty easy to do: just a few scatter plots of lateral/longitudinal/vertical plots. I will probably collapse the data into 3 bar plots with x/y error bars showing shift data pre- and post- daily image guidance. OR use the graphs I already generated that are non-directional.
• Dosimetric data that shows the consequences of changes in SSD during the course of treatment (table below shows the reduction in dose to the ICRU reference point if there is a change observed at some point during the treatment. For example, if there is a uniform 1 cm expansion of the the breast tissue for only 1 (of 16 delivered) fractions, the impact it has on the total dose the ICRU point is a 0.4% reduction.

Breast tissue	week 1					week 2					week 3
Change	1	2	3	4	5	6	7	8	9	10	11	12	13	14	15	16
1 cm+	99.6%	99.3%	98.9%	98.5%	98.1%	97.8%	97.4%	97.0%	96.6%	96.3%	95.9%	95.5%	95.1%	94.8%	94.4%	94.0%
2 cm+	99.3%	98.6%	97.8%	97.1%	96.4%	95.7%	95.0%	94.3%	93.5%	92.8%	92.1%	91.4%	90.7%	89.9%	89.2%	88.5%
1cm+LAT	99.8%	99.5%	99.3%	99.1%	98.8%	98.6%	98.4%	98.2%	97.9%	97.7%	97.5%	97.2%	97.0%	96.8%	96.5%	96.3%
1cm+MED	99.8%	99.7%	99.5%	99.3%	99.2%	99.0%	98.8%	98.7%	98.5%	98.3%	98.1%	98.0%	97.8%	97.6%	97.5%	97.3%
2cm+LAT	99.6%	99.1%	98.7%	98.3%	97.8%	97.4%	96.9%	96.5%	96.1%	95.6%	95.2%	94.8%	94.3%	93.9%	93.4%	93.0%
2cm+MED	99.7%	99.4%	99.1%	98.8%	98.4%	98.1%	97.8%	97.5%	97.2%	96.9%	96.6%	96.3%	95.9%	95.6%	95.3%	95.0%

• I like the above table, but I think it's a bit challenging to interpret ... I may need to pepper it up with some explanatory text or rejig it.
• Figures 
• Some visual explanation of how we determined what was deemed a shift that is 'in control' and 'not in control'. We merged the idea of using process control systems method and the regular standard deviation / 95% confidence idea, but I need to be able to translate this as succinctly as possible
• A visual of the workflow we currently adopt for image guidance
• A visual representing why we dropped measuring SSDs
• Explanatory Text
• There will be text associated with each of the figures and data / graphs, so that is easy. But I need to provide some context to all this stuff, which centres on my subtitle "Some guidance on image guidance, please". I need to be able to present a story of how we struggled with adopting daily image guidance in breast cancer and the challenges we faced. Some of the key things I'd like to touch on:
• Dogmas and traditions that may not be necessary in todays world and new technology
• The process was more important than the technology
• Needed and had a multi-disciplinary approach
• Focus on treatment slot times as the rate limiting factor
• The need for training, education, and documentation
• Feedback
• There were a variety of questions I wanted to ask the participants, such as
• Do you perform daily image guidance and how?
• Do you measure SSDs daily? If so how is this information used?
• Do you use CBCTs for breast imaging? If so, why and how?
• What is the most difficult image guidance site at your centre? (for us, it is breast!)
• What is the single most important lesson you've learned during your adoption of kV and CBCT technology at your centre?
• I need to find a way of capturing these ideas permanently and share them.

So, that is what I'd like to share. Now the tricky part is HOW am I going to do it? 

Unfortunately time is not on my side, so not only do we have a lot of information, I only have a  few days to cobble something together. Some random thoughts I had in organizing and presented included the following:

• Provide a hardcopy of our IGRT manual. Its tangible/physical, and something someone can flip through at their own pace
• Use printed media for presenting some of the data, figures and explanatory text. I still don't have ideas on how I'm going to do this. Alternately, I could provide access to my laptop to display raw data and some graphs directly OR just throw the figures/graphs into a powerpoint. (although this does sound a tad boring).
• Use an 'old school easle/board' with a bunch of questions and allow people to write down responses to the questions themselves. OR, generate a QR code to link to a survey monkey on precisely these questions that people could access on their smart phones at their leisure.

Last time I went a bit high-tech with my presentation. This year I'm considering toning it down a bit and using some 'old-school' methods. 

Any thoughts or suggestions are appreciated! Comment away.

My Project Gallery Revolution (Part 2)

This is the second posting in a series describing my experiment on creating a project gallery at the Canadian Organization of Medical Physics 2015 Winter School. See Part 1 for the first entry.

This year's Winter School is held at the Fairmont Hotel in Montebello. Its a beautiful location and I'm looking forward to the hotel fully constructed from logs, and the storied fireplace.

The project gallery will be hosted somewhere inside the hotel and, knowing how these things normally go, it's likely held in a conference room. The format for the gallery is as follows:

Project Gallery Presentations
During each 60-minute project gallery, a small number of conversational presentations will be held concurrently. Presenters will be assigned tables in a meeting room to display their materials (printed pages, laptop, or other media). Attendees will travel from station to station at intervals set by the session moderator. Winter School faculty will be present to facilitate these sessions. All media must be supplied by the presenter.

I needed to get some idea of what options are available within the room itself... in other words, what do I have at my disposal? After contacting the conference organizers I came to learn the following:
- project galleries are to be displayed on a half round table, which seats around 6 people
- there are ample power sources around the room
- if needed, a table closer to a wall can be acquired if one needs to display something on a wall

But otherwise, theres a lot of room for flexibility.

I spoke to a few colleagues who have attended the Winter School project gallery in the past and asked how they presented. Here is what I heard about how content is shared:
- a board that can sit atop a table, which can be presented like a poster discussion;
- printed material place atop a table, which similarly can be presented like a poster discussion, except a little less constraining.
- a laptop or computer atop a table displaying content, with the opportunity to engage with others via questioning of the content.

There's a lot of pros and cons for the above. Here is my attempt to sift through that.

Poster / board / printed content + discussion
Pros

• Can condense your thoughts into fixed text, figures, and tables
• Allows you to organize your thoughts and the trajectory of your 'story'
• Visual content can act as starting points or queues for further inquiries/questions
• Preference to those who prefer to read and digest content at their own pace
• Relatively cheap, disposable, and flexible

Cons

• Can require a lot of prep-time depending on the extent of the content presented
• Can be visually overwhelming, displaying a lot of content in a constrained geography
• Focuses inquiry/questions on the data/tables/graphs, missing the 'bigger picture' question
• Welcome to Poster tube hell!

Slides and / or  computer display + discussion

Pros

• Can include condensed content AND and an opportunity to present raw data (salivating physicists)
• Can logically sequence text, figures, and tables and generate a trajectory of your story
• Ability for multimedia / digital data etc., such as movies, jpegs, and software (with data!)

Cons

• Like posters, requires a lot of prep-time depending on the extent of the content presented
• Is "too much information" a thing for project galleries?
• Welcome to PowerPoint hell!
• Could be costly, especially if something gets lost!

What I suddenly realized was the similarity of this format to a trade convention or the vendor displays at a conference. But instead of listening to gobbledygook from a vendor, you're hearing some science, with an opportunity to ask questions. Besides the monstrous displays, what draws you to a table and not another? What I didn't want was to bore people to death, and make them endure 'the pitch', clock-watch and move on. I was hoping I could create some opportunity to display some science, have an opportunity to present it, and finally, find a way to actively engage with the audience.

Looping back to the science question(s), what I am hoping to get out of this experience is to hear about the growing pains of introducing image guided radiation therapy (IGRT) on a large and broad scale. I'm also hoping to hear about what others are doing for image guidance that are novel and unique. Finally, I would love to learn more about where people are going with image guidance.

How might I find a way to capture these thoughts from the crowd?

I'd love to hear your ideas!

My Project Gallery Revolution

The Challenge

Well it has been a few years since I panned my iPad + Poster experiment back in the summer of 2014 at the COMP annual conference (See Part 1, Part 2, Part 3  and Part 4 for the series on "Why Posters Suck") .
It was an interesting experience and I learned a great deal on presenting science in a slightly less boring way.

After many years of attempting, I've finally found a way to attend the COMP Winter School meeting (see here for more details). It is a great meeting where Quality and Safety are general themes, focusing on patient care in a multi-disciplinary setting. I'm looking forward to connecting with colleagues, technologists, physicians, academics, and patients to discover how we, collectively, might be a bit better at what we do.

To justify my trip, I submitted an abstract to one of the 'Project Gallery' sessions. I really have no idea what this means. According to the organizers:


Project Gallery Presentations
During each 60-minute project gallery, a small number of conversational presentations will be held concurrently. Presenters will be assigned tables in a meeting room to display their materials (printed pages, laptop, or other media). Attendees will travel from station to station at intervals set by the session moderator. Winter School faculty will be present to facilitate these sessions. All media must be supplied by the presenter.

As you can see, there is a LOT of leeway here on how and what might be presented. The nice thing about this format is that it appears there appear to be flexible opportunities to meet and converse with attendees... at least the ones interested in your 'Project'. I see plenty of opportunities to have a "Project" which might be a bit more engaging.

My topic would seem a tad boring: it's essentially a 'Project Management' thing with some science speckled in. Below is my submitted abstract:

Title: Change Management of IGRT in Breast Radiation Therapy: Guidance on Image Guidance, please?

Introduction: Within a span of 2 years, our centre migrated all of our radiation treatment units -which lacked kV-imaging systems- to those with MV-, kV- and CBCT-imaging systems. The rapid introduction of this technology forced a re-evaluation of how image guided radiation therapy (IGRT) is used in all radiation treatment sites, including breast. Our objective was to safely introduce these new technologies while maintaining the same treatment appointment times.

Methods: A multi-disciplinary team was assembled to determine whether existing MV-IGRT action levels and processes remained valid, determine how kV imaging might modify current IGRT practices, determine the impacts of imaging dose, treatment time, and resources on possible changes in our IGRT practice, determine best practices for assessing volumetric changes in breast tissue, provide training and education during the transition, and, to implement continuous auditing and quality improvements of IGRT practices.

Our MV-IGRT practice was based on treatment DRRs, where action levels  for tangents, mono-isocentric breast, partial breast, and deep inspiration breath hold are compared with 3 day average shifts-data (5-10 mm) or a single day’s shift (7-15 mm). Prior to transition, 92 patients with MV-IGRT procedures were audited to evaluate the appropriateness of these action levels and their workflow. The need for daily SSD treatment field measurements, for assessing gross anatomical uncertainties or volumetric changes, was heatedly debated. We examined the dosimetric impact of 5-20 mm volume changes in 3 typical breast patients across the entire breast, medially or laterally.

Results:. The MV-IGRT audit revealed 8% patients breached historical action levels. Daily no-threshold shifts using kV-orthogonal pair isocentre matching was chosen as the preferred IGRT method for all breast treatment techniques. After introduction, an audit of 86 patients with kV-based IGRT procedures revealed 13% patients breached historical MV-based action levels. Images from outliers were analyzed to rule out poor image quality or matching. An engineering “control-systems” approach was used to re-estimate action levels. A global action level of 10 mm persistent for more than 1 day was adopted for all breast treatment techniques.

We found treatment field SSD checks were insensitive to breast volume changes; instead, anterior or lateral SSD measurements close to the seroma are more appropriate surrogates for assessing volumetric changes in the breast. The ability to intervene and correct dose to the breast tissue (ex: through MU scaling) is dependent on the number of fractions delivered. Since anatomical changes not detectable with SSD checks would be detected with CBCT, we implemented regular use of CBCT in breast IGRT (at a cost of 1-2 minutes additional treatment time), particularly when SSD discrepancies exceeding 15 mm are repeatedly breached.

Conclusions: Within the span of a year, we have dramatically changed our breast IGRT practice while maintaining treatment appointment times. This has not been without challenges, such as addressing dogmas and traditions that may no longer be relevant with new technologies. Future work includes adopting better IGRT strategies for correcting rotation, boost treatments and improving training, education, and documentation.

So, the Challenge: How might I make this topic more engaging given the boundary conditions of the project gallery?

Challenge accepted. Stay tuned. If you have ideas, comment away!

Medical Physics Bingo!

With the aid of colleague (thanks Diedre) -and borrowing heavily from the interweb- we present:

Medical Physics Bingo

PHYSICIAN REQUEST TO FIX  COMPUTER	PURGE RESEARCHGATE EMAILS	WRITE REVIEW	STEAL CHOCOLATES	TECHNOLOGIST LAUGHS BECAUSE “YOU’RE JUST LIKE X FROM BIG BANG THEORY”
PRESIDENT ASKS “SO, WHAT IS A MEDICAL PHYSICIST?”	WEAR YOUR GOOD POLAR FLEECE	ABSTRACT ACCEPTED …FOR POSTER PRESENTATION	REVIEW GRADUATE THESIS	CANNOT FIND TEMPERATURE PROBE IN PHYSICS LAB
WONDER HOW MUCH  ROCK MACKIE REALLY MAKES	FIST-FIGHT OVER SOLID- WATER OR PROBE	REQUEST TO FIX  COMPUTER	MEAN GLARE FROM TECHNOLOGIST AFTER REQUESTING MACHINE ACCESS	SEARCH FOR ACCEPTANCE DOCUMENTS/ REPORTS
FAKE A PAGE TO GET OUT OF A MEETING	SOFTWARE- PATCH OVER LONG WEEKEND	“SCATTER DOSE” X2 SAID IN ONE DAY	SEARCH FOR MEDICAL PHYSICS APPS	LASER IN EYE
ASKED FOR ADVICE ON EXCEL	YOUTUBE SEARCH FOR “HOW TO COIL CABLES”	CARRY AROUND RANDO’S HEAD DURING CLINCAL HOURS	RADIATION SAFETY AUDIT FROM REGULATOR	TECHNOLOGIST REQUEST TO FIX  COMPUTER