Tattoo references are very common in radiation therapy treatment set-up, especially for those patients who had had radiation treatment in the past. In my recent rotation to finish off my treatment delivery competencies including palliative bone mets and multi-field breast treatment set-up, I have run into a lot of patients with specific references for their tattoos. On the last day of my rotation on breast treatment unit, I accidentally marked the leveling tattoo reference wrong when I was setting up the reverse decubitus breast multi-field. I tried to align all tattoos to the lasers without realizing my mistake until the observing therapist mentioned them to me. I corrected the reference and continued to put patient on their tattoo marks. At the end, I continue to make mistake while reading the depth. The incidence was later reflected on my PEF as “need minor improvement” for technical proficiency.
When the therapist pointed out my mistake, I felt very disappointed about myself because this is a very basic step in radiation therapy. I also felt very bad for my patient, who had to put up with my struggle while she was lying there uncomfortably. If I were the patient, I would have been very nervous about the accuracy of my treatment as well, which might result in a recurrence in a near future. The patient must have picked up on my lack of confidence at that point, but still gave me time to correct myself. As a therapist, I could have taken myself out to finish off the treatment and let the patient go. I am still very embarrassed when thinking back about this incidence. In fact, I truly appreciate my therapists and the patient for their patience with me.
On the other hand, I realize that I was not in a good mind set towards the end of the rotation. In the process of getting competencies for multi-field and prone breast treatment set-ups, which was not going smoothly, I became very anxious and extremely nervous. I was scared about being unable to finish up all my competencies before school ends. When I first started rotation in clinic, a therapist on my unit reminded me to read all the tabs in Mosaiq to check if there is any new doctor’s order, whether images are approved for new patient, and remember the locations of tattoos and their references for set-up before I come into treatment room. I had learned to do so very comfortably as I was progressing through the course. I have never thought that I would mark the reference and read the depth wrong in front of them, especially when I am almost near the end of clinic. Frankly, I am very regret that I let my emotion overwhelm me and affect my performance negatively.
Reverse decubitus is a very challenging set-up. It is not only a difficult position to assume, but also hard for patient to remain stable. The referencing of tattoos is therefore very important for the positioning and result of treatment. From this experience, I completely understand that I need to build a very strong confidence and learn to put my own problem behind when seeing a patient. Again, patient-center care is the primary goal. From which, I also recognize that my ultimate mission is to become a knowledgeable and responsible therapist first, in order to successfully help my patients to fight against cancers.