Overview of Radiation Therapy
The department of Radiation Oncology at the Beth Israel Deaconess Medical Center offers state of the art radiation therapy for the management of cancer and other diseases. Radiation therapy is a highly technical treatment involving an array of technologies and a large team of health care workers.
At the Department of Radiation Oncology at the Beth Israel Deaconess Medical Center, we offer state of the art equipment and software along with highly trained and experienced professionals. We provide a variety of site specific treatments along with special treatment procedures. Our multidisciplinary staff consists of board certified nurses, radiation therapists, dosimetrists, physicists and physicians. Along with specially trained administrators, social workers, nutritionists and medical assistants who provide various services to our patients. We work closely with our colleagues in the Departments of Surgery and Medical Oncology to ensure that all patients receive the best care for their particular cancer.
At Beth Israel Deaconess Medical Center it is our mission to provide the highest quality standard in clinical care, to discover new ways to improve the clinical outcome of patients with cancer, and to continue to educate our patients about cancer and the choices they can make.
Radiation Therapy Process
Radiation therapy is a complex, multifaceted, process involving many technical and clinical components. The ultimate goal of radiation therapy is to deliver high energy x-ray radiation to the patient via a small number of radiation beams. These radiation beams are designed to deliver a high radiation to the tumor while delivering very little to the surrounding healthy tissues. These beams are delivered by the treatment device, commonly called a Linear Accelerator or LINAC.
The process of radiation therapy begins with an initial consult between the patient and their physician to decide on the best treatment course for the patient. This may include such treatment options as
3D Conformal External Beam Radiation Therapy,
Intensity Modulated Radiotherapy,
Image Guided Radiotherapy, 4D Radiotherapy, Total Body Irradiation,
Cyberknife Robotic Radiosurgury. All of these options share a common treatment schedule with the exception of brachytherapy. Therefore, in what follows we will describe this common treatment path.
Once the treatment option has been decided the patient is scheduled for a treatment simulation. The simulation can take on of two possible forms: (1) a conventional, 2D, fluoroscopic simulation or (2) a 3D CT simulation.
2D Fluoroscopic Simulation
In this session the patient will be asked to lie on a table which is indexed to a x-ray device that mimics the physical motion of the treatment machine. The patient will be positioned by the simulator therapists. In addition, the fluoroscopic simulator has the ability to take x-rays from any angle that surrounds the patient. These angles are identical to the angles at which the beams that will deliver the radiation therapy to the patient with the difference that the simulator will only take diagnostic x-rays at these angles. During the simulation, these radiation beams will be decided by the simulator therapists in consultation with the treating physician. Once the number, position, size, and orientation of these beams is decided, x-rays are taken at each beam angle and the patient's skin is marked with ink tattoos to indicate where the beams will enter. There are usually a small number of tattoos, on the order of 3-5. They are small dots, approximately 1/16" in diameter.
Once the films have been taken and the patient marked, the simulation is over. These films, and all patient information regarding the simulation is digitally uploaded to the radiation therapy management software system call MOSAIC. This software system is quite comprehensive and will be described in a later section.
3D CT Simulation
In this session the patient will be asked to lie on the CT table. The patient will be positioned by the simulator therapists and a CT scan will be obtained in the approximate area that is to be treated. Once the CT is obtained it is exported to FOCAL SIM, the simulation software suite. Once in FOCAL SIM, the physician reviews the CT scan and can defined in three dimensions all organs of interest. The CT simulation is superior to the 2D fluoroscopic simulation in that it allows for a full three dimensional definition of all organs of interest. In addition to the organs, the beam can now be designed in three dimensions which allow for a more exact treatment plan. Once the geometric plan is complete, the software will then direct the therapists as to where to tattoo the patient for setup on the treatment machines.
Overview of 1st day of Treatment Delivery
You will arrive for your first day of radiation treatment, at the Radiation Oncology Department at Beth Israel Deaconess Medical Center in the Finard Basement - East Campus. When you first enter the department you will be greeted by our administrative staff that will check you in and further assist you to our patient waiting area.
Once seated in the waiting area, you will be approached by your primary nurse, whom you've already become acquainted with at your simulation date. She/he will meet with you and in depth discuss what to expect during your course of treatment and answer any questions or address any concerns you may have. Once finished she/he will guide you to our patient changing/locker area and give you further instructions.
During your instruction with your nurse, she/he will give you a "blue card." A "blue card" is our way of electronically bringing up your treatment chart in the treatment console and it also lets us know when you have arrived for your treatment. It is a part of our intensive quality assurance program here at Beth Israel Deaconess Medical Center. You will scan your "blue card" at the desk in front our medical assistant and then take a seat.
Once ready, your radiation therapist team will come out and introduce themselves to you. These are the people that will be giving you our daily radiation treatments. They will guide you into the treatment area. Take note that the therapists will not be in the room during your treatment, but there will be video surveillance and a two-way intercom to monitor and communicate during your treatment. This is also a part of our quality assurance program.
Once inside the treatment room, you will see the linear accelerator. The therapists will then assist you on the treatment table and into the same position you where in during your initial simulation. They use lasers in the room to line up the tattoos/marks given to you at your simulation date. Once your treatment is set up, the therapists will leave the room. You are to relax, breath normal and remain still. It is essential to your treatment that you do not move once the therapists have left the room.
The therapists will then take a few x-rays. These are ensure that everything is the same as it was on the day of your simulation. This is also a part of our quality assurance program. The physician will then look at and approve the x-rays for treatment. The therapists will then give your treatment. When the beam is on it has a loud buzzing sound, but you cannot feel anything and nothing will touch you. Treatment times vary from patient to patient. A treatment time can last anywhere from 5 minutes - 1 hour. Your therapists can explain your time further in depth to you once you arrive. Once the treatment is over, the therapists will re-enter the room, help you off the table and you can now leave the department.
Your first day of treatment will always be the longest day you will be on the treatment table. This is because of all the quality assurance events that take place on that first day. Please feel free to ask any member of your treatment team any questions or concerns you may have.