u/SnooCamera

I did not see a paywall.

Today I learned something new. I chose radiation (SBRT) for my treatment. I went out of state to an NCI designated center of excellence. What I did not know at the time and learned today is that the American Society for Radiation Oncology, has an APEx Accreditation Program for Radiation Oncology centers.

APEx accreditation actually is a voluntary accreditation program for radiation oncology practices. It acts as an independently-verified stamp that a practice follows a specific set of national quality and safety standards across every part of the treatment process, not just the equipment.

There are guidelines for treatment planning, evaluation, follow-up, staffing, culture of safety, equipment maintenance, peer review (like tumor boards), and the big one, safety checks and cross checks.

(That is, this is the big one for SBRT since you are talking such high dosing per fraction): Before every single session there's a mandatory "timeout" verifying your identity, treatment site, positioning, and plan. The same idea as surgical timeouts. Physics has to independently double-check the dose/MU calculations before you're ever treated, and again if anything gets replanned mid-course. Multi people have to sign off and review it.

Basically, if a center has APEx accreditation, it means an outside body actually audited their charts, their QA logs, their staffing, and their safety culture, not just their machines. For anyone shopping around for an SBRT or any type of radiation treatment center, it might be worth asking "are you APEx accredited?" alongside the NCI designation question.

I'm sorry I can't give you a link due to new sub rules, but you can look up accredited centers on ASTRO's site under the heading of APEx Accredited Facilities, if you want to check where you're being treated (or where you're considering).

Seems like a decent price.

Transparent is $15.99 https://www.amazon.com/IEMAI-Polyurethane-Dimensional-Compatible-Transparent/dp/B0GHDHHQL8

Assuming it ships, I bought one of the last listed online 13* inch Macbook Air M5 16/512 at AAFES military exchange for $899.

I kind of panic bought with the price announcement day before yesterday.

I thought about more RAM for AI, but I felt having no fan would be a limiting factor. Plus, my budget was tight.

I cant remember all the Macs Ive owned, but I think:

Mac Classic

Mac LC

Powerbook 100

Performa 610 with PC daughter card

Performa 6100 (av?) with power PC 601

Powermac G3

Mac Mini Intel i5 (late 2012 I think)

Mac Mini M1

Mac Mini M4 (current use)

(Around late 89 or 90, I also had an SE/30 at work)

If I dont have all the details right, excuse this old man's memory.

I just finished my 5th and final round of SBRT today. There's a bell in the lobby, the kind a lot of radiation oncology centers have, and the unspoken expectation seemed to be that I'd walk over and ring it on my way out. I didn't.

I have seen a couple post mention it. So, it had been on my mind. I did put some thought into it. It got me thinking, if you will pardon the pun, for whom does the bell tolls? Was it a release for me, or was I just basking in my own glory, "HEY, Look at me!" (To be clear, I'm only applying this to my personality, not any of you. It's a personal decision, no shame either way)

It wasn't a dramatic decision. I was not making a statement or a stand. I was in a good mood. I stood there for a second and looked around the room first. There were a few other patients waiting, and a couple of them looked rough; that specific kind of tired and braced-for-bad-news look you recognize after you've spent time in these waiting rooms yourself. I'm not sure if you have done it, but I've looked at others wondering what they are 'in for.' Likewise, for those making eye contact there's a knowing, yeah me-too buddy, look you get. It is just human nature.

Looking past myself, I didn't think my ringing a bell was going to give any of them hope. If anything, I thought it might do the opposite: remind someone mid-fight that they're not done yet, while I get to walk out the door. Out the door, free (at least for now). That felt like it could land as a gut punch more than a celebration, and it would've broken the quiet, heads-down mood of the room in a way that people didn't ask for. People who did not sign up for that.

I'm not all that bright, so I figured it was something that had been looked into. When I had asked about my last day, so I could make plans, my doctor mentioned something interesting. So, I looked too.

Turns out there's actual research backing up my uneasiness. A 2019 study by Williams et al., (The Cancer Bell: Too Much of a Good Thing?)published in the International Journal of Radiation Oncology, Biology, Physics, followed about 210 patients finishing radiotherapy, roughly half of whom rang a bell at the end and half who didn't. The patients who rang the bell actually reported higher distress about their treatment than the ones who didn't, and at the 3-month follow-up, that gap had widened. The researchers' theory was that the emotional intensity of the bell-ringing moment doesn't lock in a triumphant memory. No, it locks in a more vivid, more distressing one. So, I had this on my mind too.

Counterintuitive, but it lined up with what I was sensing in that room. What memories, what "emotional arousal" would I lock-in for them in that moment?

There's also something more personal in my decision. I did SBRT- 5 fractions. I know plenty of people on here have gone through 8-9 weeks of conventional fractionation, plus hormone therapy, plus everything that comes with it. Ringing a bell after 5 fast sessions felt like it would've been claiming a victory lap I hadn't really earned compared to what others in that same lobby were grinding through. It felt like I'd found a cheat code and gotten a great loot box and celebrating that in front of people mid-marathon didn't sit right with me.

So, I just quietly walked out. No bell, no ceremony. Just grateful, and aware that the room wasn't only about me.

My brothers here, you are heard. Your road will be different than mine. If you need to ring that bell, you ring it loud, you ring it proud. Hang in there.