HJBR Jul/Aug 2021

HEALTHCARE JOURNAL OF BATON ROUGE I  JUL / AUG 2021 13 into the major levers that affect health pol- icy around cancer care in the U.S., enjoyed it to the extent that I reenrolled into the MBA program at LSU and got an MBA. I think that really helped pave the way for my involvement in administration here at the cancer center for the last four years, during which I’ve served as the chief oper- ating officer. I think the way that I enjoy the two different roles, chief of medical physics and chief operating officer, is very different. The medical physics activities that I’m still involved with, I derive a lot of satisfac- tion from, because I’m passionate about it. It’s why I got into the field, and there’s a lot of personal satisfaction and interest from getting involved in things that I really understand and have trained specifically to be able to do. I will say, the chief operating officer role was more challenging. It’s more challenging because it’s more diverse, and it falls into a category of things that I have less domain- specific training to be able to tackle. But I will say that when there are successes, those successes that I experienced in the COO role transcend anything that benefits me person- ally or a particular project that I’mworking on, it impacts the organization as a whole. So, for me to see cultural changes or pro- grammatic things that are brought online that can benefit all of our staff or all of our patients and doctors is really empowering and invigorating. Editor I’m going to ask you to put your chief of physics hat on for a second. Tell us about your relationship with radiation, the impact it has on cancer care, and if you ever have dreams about glowing in the dark. Fontenot Well, my dreams of glowing in the dark were dispelled probably in my first week of graduate school. So, that was ruled out pretty early on, but it’s certainly a question that, honestly, a lot of patients have questions about, and there’s a lot of mystery and curiosity about radiation. There are a lot of facts that we try to give patients about the effects of radiation, but glowing isn’t one of them — even though that would be a really neat trick if we could pull it off. Physics is an essential part of oncology care in general, because oncology is very much propelled forward by technology. I mean, technology impacts all parts of medi- cine, don’t get me wrong, but I would char- acterize oncology as being on the leading edge of technology with respect to hard- ware, software, whatever the case may be. We’re relying on evolutions in technology to help really propel cancer care forward, and the medical physicist can be thought of as the shepherd of technology within the oncology department. The medical phys- icist is the local science nerd who under- stands the technology, who understands how it works, who knows how to integrate it within the clinical system, who knows how to instruct or advise physicians and staff on the best use of the technology to make sure we’re getting the most out of it and to make sure we’re using it in the safest possible ways. Editor Radiation on some cancers may be the most effective treatment we have today, but for many, it does not come without con- sequences. What advances have you seen and see on the horizon for radiation treat- ment effect? Fontenot Great question. Radiation is one of the three pillars of cancer care. If you’re boiling it down to the simplest form of what your options for treatment are, you have surgery, you have chemotherapy and you have radiation. There are some other developments that are ongoing and grow- ing, but those continue to be the three major pillars of cancer care. Radiation is powerful, because it brings together the best of both worlds between surgery and chemotherapy. Surgery is great, because you can physically remove cancer tissue, but you can’t do it everywhere because you can’t get to every- where. And, not all patients are candidates for surgery. Chemotherapy is very effective because it is systemic — it reaches all parts of the body — so it’s very effective at getting to those areas of the body where we may not even know that cancer exists. Radiation is a great compromise between those two, because we can target it. It’s not as systemic as chemotherapy is, but we can also reach areas of the body that surgery cannot get to. The downside, of course, as you mentioned, is that there is the risk of side effects associated with radiation ther- apy, and the type of side effect that some- body might experience depends on their type of cancer and how that cancer is going to be treated with radiation. We’ve seen a tremendous amount of progress within radiation therapy in reduc- ing side effects over the last probably 10 or so years by utilizing imaging more heavily to target our radiation beams. Today, when a patient is treated with cancer, we utilize three-dimensional imaging to be able to visualize, to see the location of, the tumor and the location of the critical structures that we’re trying to avoid before each treat- ment. We can see that better before each treatment; we can aim our treatment fields more accurately. We’ve been able to reduce the amount of healthy tissue that we have to treat through during a course of radia- tion therapy. The next big thing that is coming is going to be another paradigm shift that is also dependent upon better use of imag- ing before treatment: the use of imaging to not only tell us where to direct or point our radiation beams, but also to change the treatment plan entirely on the fly each and every day. That paradigm is called adaptive radiation therapy. What adaptive radiation therapy is, is not only placing the radiation fields in accordance with where the tumor is but changing them to take advantage of any advantageous movement of the criti- cal organs around the tumor that gives us a better window to be able to treat the cancer. Editor That makes sense. Is it happening now? You said it was futuristic.