Sales Insanity
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FFYes, I know, the thread title is a tautology.
In radiotherapy we treat some patients on what we call a linear accelerator. It's a big thing that pumps out some radiation. To make sure we do this in a way that makes people better, patient positioning is very important. We want the radiation to hit the tumour in their lung, rather than the completely healthy left arm. To do this, patient are tattooed the first time they lie down on the treatment couch at spots highlighted by the treatment room lasers. This usually produces positions that are within an inch of where things really should be.
While for some tumours this is enough precision, for many it is not. To this purpose most linear accelerators have an imager. Think of it as an integrated miniature CT. You take a CT with it, overlay it with the CT you took the first time the patient was in and match on their bone structure. With this, you can see if the position is a few millimetres off.
The software system then calculates something we call a spatial registration object SRO. That's basically just a vector that then gets sent to the couch motor. 2mm to the left, 3mm up and 1mm back. There we go: patient good to treat.
For the SRO to work the imager software needs to play nice with the overall oncology suite - so they can be recorded, sent back to the treatment machine and be verified.
Recently, my company has been pushing to sell updates to the imager software that allow some funky things. As usual, there was no backwards compatibility testing. The system is amazing should you happen to have the newest oncology suite 7.0.
However, if you happen to use oncology suite 6.0 you are screwed.
For some very good reasons the licensing system in the imager software was overhauled and the way some things work was changed to be compliant to work with new medical standards. One of these changes was that Microsoft message queuing is no longer used to send the SRO. However, sending SROs by DICOM is a new licence for users of version 6. It's an automatic feature of version 7.
So here we are with customers who have 6.0 and the old software. Everything works. They can position patients accurately. They upgrade, are told they don't need new licences and suddenly no SROs for them. As you can imagine this is a big deal when treating patients.
Within most of Europe we got the sales people to give out the missing DICOM licence away for free in the interest of quality of care. Everywhere, except Germany.
When I told their sales person about this unfortunate consequence of the rewrite their response was: "Well, Germany is not part of Europe. I don't see why I'd have to do this. It's a 20 000 Euro licence and I get a 0.2% bonus of what I sell. Not doing it."
Isn't that just about enough to make one wish this person actually got cancer.
I called up the head of European Sales to have this funky mess fixed. He seemed to still remember this historic moment between Germany and France midway through the last century and that pesky currency Union we have.
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He should try and sell them the 7.0 system software for 100k it even gives him more bonus!
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The reason that doesn't happen is because the upgrades take months to complete and have different hardware reqs. He did try to go down the route of the hospital having to re-school their entire staff, buy new servers and wait months before being able to treat again in favour of giving a tick away for free though.
I just told him to stuff it where the sun doesn't shine.
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Maybe you should "offer" him to deduct 0.2% of the loss of earnings your company will get sued for from his salary?
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I am fond of this idea :)
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Most probable course of action. The company gives him 400 euro for each licence which is given away to compensate him for his inconvenience.
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patient positioning is very important.
I read this as "patient poisoning is very important" and thought
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Sounds more like chemo then radio therapy ...
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Well, Germany is not part of Europe.
Give them a lesson in some fucking geography, or something.
And please whack them in the kneecap so they can put that bonus to a good use. Thank you.
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I read this as "patient poisoning is very important" and thought
Technically, well... Radiotherapy and chemotherapy are precision poisoning if you look at it that way. A matter of choosing lesser evil, methinks.
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Are we going for another Therac-25?
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Most probable course of action. The company gives him 400 euro for each licence which is given away to compensate him for his inconvenience.
40, not 400.
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Are we going for another Therac-25?
Ah, that's the name I was trying to remember, thanks! :)
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I stand corrected and an even faster decision by the manager. Probably the conversation of @roayl_poet and the salesperson has costed the company more.
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That works? Around here that's slower then molasses.
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patient are tattooed
I've heard this before--is this usually a permanent thing? If not do you redo the tattoo every time they get radiation or what?
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That works? Around here that's slower then molasses.
it usually is.
if i'm being honest it's more i pay attention to names because if i'm going to namedrop @‌b‌o‌o‌m‌z‌i‌l‌l‌a for example i want to make sure they get the notification.
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I've heard this before--is this usually a permanent thing?
Tattoos tend to be permanent, yes. that's rather the entire point of a tattoo really.
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I read this as "patient poisoning is very important" and thought
Your post made me think of the famous Tom Lehrer song, Poisoning Patients in the Park.
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Tattoos tend to be permanent, yes. that's rather the entire point of a tattoo really.
We should invent a thing called a temporary tattoo. Oh, wait....
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We should invent a thing called a temporary tattoo.
yes, but then a temporary tattoo and a tattoo have very different design goals
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No kidding. I'm just saying, if there's an opportunity for me not to permanently mark up my body I'd prefer to take it and I'd assume a lot of people feel that way.
I've read stories about people who've had this kind of treatment and it called them out as having gotten permanent tattoos of their alignment marks, without saying whether that's normal or not. That kind of thing makes me think it's done deliberately as some kind of memorial, which rather naturally leads into wondering whether the marks are normally permanent or not.
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if there's an opportunity for me not to permanently mark up my body I'd prefer to take it and I'd assume a lot of people feel that way.
well, AIUI, the reason the alignment tattoos are there is so they don't have to take a set of x-rays and catscans every time you come in for radiation.
I don't think they're exactly optional, but then this is secondhand and third hand information here. Consult an actual expert before taking my words as fact.
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Consult an actual expert before taking my words as fact.
It's almost like that's why I was asking @royal_poet, who may not be an expert per se but probably knows or can easily find out!
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@accalia said:
i actually get peoples names right.
because of the autocomplete?
Discourse autocomplete works?
:news_to_me:
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Discoworks.
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I look after chemo sites as well. When I have time to write up some more WTF I shall. Trouble is I need to raise disco TL. I would rather put that in the lounge though. Confidentiality is a thing.
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That's how it's usually explained to patient's and it is technically true that you could just position with CTs/ 2D imaging and SRO vectors.
Reality is that a patient on average has 8 minutes in a treatment room and there is no time for doing a CT, shifting, doing a second to verify, maybe shifting again.
So instead we align to tattoos, take a CT, verify, one shift: treat. And that is within the clinically relevant margin of error.
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Reality is that a patient on average has 8 minutes in a treatment room and there is no time for doing a CT, shifting, doing a second to verify, maybe shifting again.
Sure, that makes sense, but for all I know there's a kind of ink that biodegrades after 6 months, or some period that's long enough that it'll last longer than the median interval between two treatments.
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Trouble is I need to raise disco TL.
There are ways to achieve this fast. /t/1000 was the fastest.
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Well that is why I am always wondering why I am the one who is coding in our group. Due to dyslexia it always filled with all kinds of errors.
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There are ways to achieve this fast. /t/1000 was the fastest.
50 days of attendance is almost always the most difficult threshold. Almost.
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There is rarely that much care taken with the ink as it is just a tiny dot and you don't see it unless you go looking. Also, most patients are old enough to have wrinkles to hide them. On child patient they might do markings with permanent marker pen and refresh them every few days or take the time for a double match with a CT... though there is a flip-side to that as CT equals extra radiation. And we generally avoid that in young patients.
Radiotherapy quickly gets complicated.
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Trouble is I need to raise disco TL
@shadowmod trust royal_poet
(which would work if i was TL4+ according to shadowmod)
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username: accalia trust level: 3 (Not locked) In the last 100: Visits: 100/50 Topics Replied To: 523/10 Topics Viewed: 1086/264 Total Topics Viewed: 6976/200 Posts Read: 1839075331/23181 Total Posts Read: 1839469821/500 Flagged Posts: 0/5 (max) Flagged By: 0/5 (max) Likes Given: 4318/30 Likes Received: 12210/20 Liked on Days: 101/7 Liked by users: 169/5 Status: Above requirements.
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woosh :) That just went over my head
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There is rarely that much care taken with the ink as it is just a tiny dot
Ah! The very few examples I've seen of it were somewhat more elaborate, like, IIRC, a dashed circle an inch or two across.
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Posts Read: 1839075331/23181
err..... what?!
1.8e9 posts read in the past 100 days?!
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We haven't had a good  for lately, so here's one on you.
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What, you wanted one too? I can arrange that.
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@accalia said:
@shadowmod
try it again, but with the word trust in there too. ;-)
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I don't understand why you removed this feature in 6.0 when you released 7.0.
Even if you give the license for it out for free, what the shit man?
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@shadowmod trust
Alrighty then. The marvels of bots.