Sanjay Mehta, M.D.

And they can leave feeling the same as when they got there, just like getting any x-ray. They jump in their car and go right back to work or to the gym or the golf course.

And they can leave feeling the same as when they got there, just like getting any x-ray. They jump in their car and go right back to work or to the gym or the golf course.

So I was in residency in the late 90s, early 2000s. So it was a very interesting time because we were at the cusp. My first year of residency, and I was at UTMB in Galveston, it was a combined rotation with MD Anderson. So we were at a time, this is 1998, we're talking about where At the end of the old era, we didn't even use CT planning.

So I was in residency in the late 90s, early 2000s. So it was a very interesting time because we were at the cusp. My first year of residency, and I was at UTMB in Galveston, it was a combined rotation with MD Anderson. So we were at a time, this is 1998, we're talking about where At the end of the old era, we didn't even use CT planning.

We just had a couple of orthogonal films and we were literally drawing our tumor volumes out with a grease pencil on a physical x-ray and using that cutout to go trace a styrofoam negative and make a metal or a lead alloy block, which you would slide this basically this aperture in the path of the beam. That's the way it was done for decades.

We just had a couple of orthogonal films and we were literally drawing our tumor volumes out with a grease pencil on a physical x-ray and using that cutout to go trace a styrofoam negative and make a metal or a lead alloy block, which you would slide this basically this aperture in the path of the beam. That's the way it was done for decades.

And so we were still doing that when I started residency. But by the end of residency, we had full-on CT planning where now we're doing a full CT scan, doing everything virtually. And of course, it's far more precise and you can model multiple different iterations. Okay, do I want a beam coming in from this angle? Do I want to bring in an orthogonal beam from here?

And so we were still doing that when I started residency. But by the end of residency, we had full-on CT planning where now we're doing a full CT scan, doing everything virtually. And of course, it's far more precise and you can model multiple different iterations. Okay, do I want a beam coming in from this angle? Do I want to bring in an orthogonal beam from here?

Do I want to block out a little bit more of the chest wall to get the heart dose down? I can see all that stuff now. So by the time I finished residency, we were basically doing what we do now, albeit with much slower computers and Just being in the infancy of that, it was probably more like 20 to 30 minutes per patient.

Do I want to block out a little bit more of the chest wall to get the heart dose down? I can see all that stuff now. So by the time I finished residency, we were basically doing what we do now, albeit with much slower computers and Just being in the infancy of that, it was probably more like 20 to 30 minutes per patient.

But the last 15 years, roughly, to answer your question, things have been much more automated. And instead of having lead blocks that you're sliding into the path of the beam, now everything is shaped in the head of the beam by our computer. So you hit a button.

But the last 15 years, roughly, to answer your question, things have been much more automated. And instead of having lead blocks that you're sliding into the path of the beam, now everything is shaped in the head of the beam by our computer. So you hit a button.

And when I've already programmed the treatment planning values, the machine knows how to shape the beam to match the aperture of whatever you're trying to do. So that's all fully automatic now. So the therapist job, we have a radiation therapist who actually positions the patient in the room. They get them in position.

And when I've already programmed the treatment planning values, the machine knows how to shape the beam to match the aperture of whatever you're trying to do. So that's all fully automatic now. So the therapist job, we have a radiation therapist who actually positions the patient in the room. They get them in position.

They take a picture x-ray first, either a cone beam CT, which is a low-dose CT, or just a PA in a lateral film. And we actually overlay that with our planning imaging to make sure that the original reference from the planning day matches today's image. The machines will actually superimpose the daily image with the reference image. So everything is automatic. I can see, okay, are we directly on?

They take a picture x-ray first, either a cone beam CT, which is a low-dose CT, or just a PA in a lateral film. And we actually overlay that with our planning imaging to make sure that the original reference from the planning day matches today's image. The machines will actually superimpose the daily image with the reference image. So everything is automatic. I can see, okay, are we directly on?

If everything lines up correctly, then we literally have two images that look identical. I just see one image, which if it's slightly off, if there's even a few millimeters this way or that way, we account for that by moving the table. The table is motorized.

If everything lines up correctly, then we literally have two images that look identical. I just see one image, which if it's slightly off, if there's even a few millimeters this way or that way, we account for that by moving the table. The table is motorized.

So the patient will be laying there and they'll feel it move just a few millimeters this way or that way until we have perfect concordance between the daily setup and the original. That's really, really improved our accuracy. And the regional miss, the geographic miss, which was a problem in the old days when we didn't have digital imaging and all this stuff, is essentially gone now.

So the patient will be laying there and they'll feel it move just a few millimeters this way or that way until we have perfect concordance between the daily setup and the original. That's really, really improved our accuracy. And the regional miss, the geographic miss, which was a problem in the old days when we didn't have digital imaging and all this stuff, is essentially gone now.