City of Hope Entrance

Unexpected Life Changes

By

Marvin Collins, July 20, 2007

View from the City of Hope

 

After retiring from my position as Chief Engineer for KFI and KOST in Los Angeles, my wife, Herta, and I were fortunate to be able to make cruises in various parts of the world and ski trips to Utah in 2003, 2004, 2005 and 2006, all while I continued my part time job, taking care of KBLA, plus doing occasional remote broadcasts for various stations. Retirement continued to be good. Boredom has not been a problem. I think I was bored once for about ten minutes until I remembered the next household or ham radio (W6OQI) project I wanted to do. Usually I find the days come to an end and I have not done all that I wanted to do that day.

As the saying goes, life is not always a bowl of cherries. On January 24, 2007 we made the final payment on a cruise to Australia, Tasmania, New Zealand, Fiji, American Samoa and Tahiti. On January 26 I had my annual blood test which includes a PSA test (Prostate Specific Antigen), which I assumed would be normal as in previous years. On January 30 I received a call from our family doctor saying I may have a problem because my PSA was 4.55, up from 3.29 the year before. Generally you do not want to see a PSA above 4.0. This was too much of an increase for one year. The family doctor did not say I had prostate cancer but it was time to see the urologist for a prostate biopsy. I have to say it was a time of anxiety waiting for the results of the biopsy. Two days later the bad news was that the biopsy showed early stage prostate cancer. This definitely was not the news I wanted, though I was not too surprised because my father died of what started as prostate cancer but was not diagnosed early enough.

During a lengthy discussion with the urologist about the treatment options I could see I had a lot of research to do in order to decide which treatment option to pursue. The first option mentioned was surgical removal of the prostate gland. I did not care for this option. I then studied various forms of radiation therapy. One interesting option is brachytherapy, the placement of radioactive seeds into the prostate gland to kill the cancer. Another form of brachytherapy is the insertion of hollow tubes into the prostate gland through which radioactive material is placed for a limited time as controlled by a computer. Brachytherapy is often accompanied by a period of a few weeks of external radiation.

While researching all of this I came across www.tomotherapy.com and was very impressed with this new system for non-invasive treating many forms of cancer including prostate cancer. Tomotherapy offers accurate precision aimed radiation of the tumor with minimal radiation of the surrounding tissue. For detailed information visit www.tomotherapy.com.

After revisiting www.tomotherapy.com and reading more about the treatment I felt this was the treatment for me. The Tomotherapy web site contains a list of hospitals offering the treatment. I found the City of Hope National Medical Center in Duarte, California to be the closest to my residence. I called City of Hope and made arrangements for a consultation with one of their doctors, Dr. Jeffrey Wong. After consulting with Dr. Wong for about an hour we agreed that Tomotherapy would be an appropriate treatment for my prostate cancer. Dr. Wong explained that empirically it has been determined that 76 units of radiation, known as Grays, are needed to kill prostate cancer. One gray dose is equivalent to one joule radiation energy absorbed per kilogram of organ or tissue weight. In my case the radiation via Tomotherapy is delivered at the rate of 2 Grays per day for 38 days to make the required 76 Grays. So far side effects have been minimal and I am delighted with Tomotherapy. Of course it will take some time after treatment to determine if the Tomotherapy was successful. Dr. Wong believes the 38 days of treatments will be all that I require. Time will tell.

You may wonder why I have been telling you about all of this. There is a moral to this story. IF YOU ARE 50 YEARS OF AGE OR OLDER BE CERTAIN TO HAVE YOUR ANNUAL PSA BLOOD TEST. Prostate cancer is very common in men over fifty and it is important to catch it early, as I did.

I would like to give a thank you to the staff at City of Hope for their kind and courteous treatment and a special thank you to Carmen Grau the Radiation Therapist who greets me every day at Tomotherapy machine number one. Today is treatment number 38 of 38. This is the end of my daily trips to City of Hope for the past eight weeks. A follow up visit will take place in a month. After that I will return to City of Hope every four months for PSA testing to be certain the prostate cancer has been eliminated.

 

Treatment and Technology

The Tomotherapy Machine Uncovered

I'm ready for the Treatment

After being a patient for a short time I became interested in the inner workings of the Tomotherapy Machine.  Luck was with me when I happened to have my camera and one of the two machines at City of Hope was down for repairs.  It was a bit amusing when one of the radiology therapists came in the room while I was helping the Tomotherapy technician remove the cover from the machine.  The radiology therapist had a puzzled look on her face when she saw me, a patient, helping the technician.  It was very interesting to take a close look at the technology inside the machine.      

The photo shows the linear accelerator at the top. You can click on the photo for a close up. On the left side is a high voltage supply.  On the right side is a magnetron with a flexible wave guide on top that feeds microwave energy to the linear accelerator.  This entire front portion of the machine rotates around the patient.  In the photo the machine is parked in the home or maintenance position.  Looking through the center hole you can see a large brass colored ring which is a slip ring assembly that passes 65 PSI compressed air to the computer controlled pneumatic valves seen in front immediately above the center hole.  The pneumatic valves control the multi leaf collimator which forms the photon beam from the linear accelerator in a precise manner. 

As the entire assembly is rotating around the patient the beam is modulated in shape and size under computer control.  The computer is programmed based on data previously obtained from the patient via MRI and CAT scans.  The need for repair this day was caused by the brass colored compressed air slip ring failing by blowing its gasket seal.  This permitted the compressed air to escape and control of the multi leaf collimator was interrupted.  I don't know if this happened while a patient was being treated.  The Tomotherapy machines run all day with the gantry rotating so it could have happened at any time. 

Even if a patient had been undergoing treatment there would have been no hazard.  On the opposite side of the gantry from the linear accelerator is a photon radiation detector that monitors the dose.  If that is not correct the machine discontinues the radiation.  Many parameters are monitored and if any are not correct the machine will not radiate.  During the course of my 38 treatments there were two interruptions.  One time a circuit breaker tripped and everything stopped.  Another time the radiation therapist had to shut the machine down and restart it again.  I guess two out of thirty eight is not bad when you consider how complex the Tomotherapy machine is. 

I believe the magnetron is water cooled.  On the rotating portion of the machine I could see a water cooling system that included a small radiator with fans.

Thanks to the technology, it was my good fortune to have been able to experience such a non-invasive treatment.

 

Posted and Edited by Steve Blodgett, Earthsignals.com