Inside this issue: Radiation Therapy (a joint issue with ESTRO) and EONS at ECCO 2017

From oncology nurse to “proton expert”

Ingrid Kristensen, a Swedish nurse, tells the story of her career path in radiotherapy, describing how she developed her expertise in this specialism

Ingrid Kristensen

Ingrid Kristensen

I started my training in 1982, when the education system had just changed. Previously, my future colleagues in the radiotherapy department were called radiotherapy technicians, now we would be nurses! Added to the training was both oncology practice and more on chemotherapy, but also more general nursing. Still, the main focus was radiotherapy physics and practice. This was the part that I really liked and where I felt at home. What I liked the most was treatment planning – and I started my career there, in the Radiation Physics department at the University Hospital of Lund, in Sweden. We switched between treatment planning, patient dose measurement and helping physicists with machine QA (quality assurance). At this time we still did some of the treatment planning by hand (fig 1) but we had an in-house treatment planning system as well.

Figure 1. Cranio-spinal irradiation, made in the late 80s

Figure 1. Cranio-spinal irradiation, made in the late 80s

A longing for physics!

For a couple of years, I switched to working in Linköping, in the Radiation Therapy Department. But I longed to get back to physics and, when there finally was an opening, I moved back – and I really haven’t left since, even though my work has taken me to many different corners of the radiotherapy world.

I came back to exciting times. A new 3D treatment planning system had just been commissioned and we could suddenly use full CT-studies, even though there was a limit to the number of CT-slices (computer-processed combinations of many X-ray images taken from different angles to produce cross-sectional images) that could be imported. After a few years, we switched to a new planning system. Now, I started to get involved in various projects concerning treatment planning as well as working part-time as an application specialist. I also started to study for a bachelor’s degree. Around that time our family expanded, with two boys.

When I got back after my second maternity leave, I got more involved in dosimetry (the calculation and assessment of the radiation dose received by the body), working with the physicists and engineers on QA of our machines. Somewhere along the line I was asked to be a part of a project to set up national video conferences for paediatric radiation oncologists. This project enlarged my professional network in many ways. Getting involved with the Swedish work group for Paediatric Radiation Oncology also took me back to treatment planning in many ways. My experience with the national network on video-conferencing as well as treatment planning and paediatrics suddenly brought me into the group preparing for the national proton centre Skandionkliniken (Fig. 2).

Figure 2. Interior from one of the gantries at Skandionklinken.

Figure 2. Interior from one of the gantries at Skandionklinken

I had been involved in procurement previously and this gave me a unique chance to learn a lot about proton therapy, from the cyclotron/synchrotron to the creation of treatment plans and treatment. Today, I work in part with the paediatric group registering all children in Sweden receiving radiotherapy, and in part with treatment planning, mainly for proton treatment (Fig. 3), and with our national Proton school to make sure our distributed competence is high and relevant in the field of proton treatment planning. I’m also about to finish off my doctoral thesis.

Figure 3. Cranio-spinal treatment with tomotherapy to the left, 3DCRT in the middle and protons to the right. In this case there is a better sparing of normal tissue with protons than with photons.

Figure 3. Cranio-spinal treatment with tomotherapy to the left, 3DCRT in the middle and protons to the right. In this case there is a better sparing of normal tissue with protons than with photons

So, I have learnt a LOT over the years, mainly, I guess, by not “sitting still” but also through cooperation with others – with both dosimetrists and physicists within the departments, but also through the wide network of colleagues I've been fortunate enough to build! I enjoy my work immensely and I'm grateful to still be able to see the field of radiotherapy developing and growing.