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What to Expect

Introduction

Your doctors have recommended that you receive Cyberknife Radiosurgery (CK) at the Beth Israel Deaconess Medical Center. This technology is amongst the most accurate delivery systems for treatments with high doses of radiation. These treatments are generally given within one to five sessions, depending on the patient's needs. Each treatment session may last up to two hours.
    Before your first day of treatment, you will need to come to the hospital for a number of appointments. The purpose of these appointments is for the treatment team to gather the needed information on your condition and preparing you for the CK treatment. A nurse from the CK program will coordinate all your appointments, help you throughout the treatment process, and answer questions. It may take up to two weeks to schedule all the needed appointments. The CK nurse will contact you once your appointments are scheduled.
    We understand that waiting for your appointments and your CK treatment can be difficult. Please be assured that your Cyberknife health care team will be available to you throughout this process.
    This guideline is provided for information about your upcoming appointments and your Cyberknife treatment.

Upcoming appointments prior to CK treatment

Depending on your specific case and treatment site, the following appointments may be necessary. It is very important that you keep them all and arrive as scheduled. For all these appointments, please wear comfortable clothing.

Fiducial placement

For treatments sites below the neck, it may be necessary to place gold markers (also called fiducials) into the tumor. Through these markers the Cyberknife System will track the tumor's position during treatment. The markers will be placed in an outpatient area at the medical center or by a surgeon in the operating room. Your CK nurse will let you know when and where your markers will be placed. Because you may need sedative medication when the markers are placed, you will need someone to drive you home after this appointment.
    Once these markers are implanted, they need to "sit" for one week before the next phases of your appointments may begin.

Magnetic Resonance Imaging (MRI)

For patients with conditions involving the head, neck, or spine, magnetic resonance imaging (MRI) may need to be done as part of the treatment planning process. MRI imaging provides the physician with a detailed look at the target as well as surrounding structures. The MRI scan uses a strong magnetic field, radio waves to make images of areas of interest inside of the body. MRI does not use x-rays.
    Your MRI will be done in one of our radiology department sites. During your MRI, a special dye will be injected into a vein, usually through an intravenous (IV) line in your arm. A new IV may be needed even if you have a long-term intravenous device, such as a port-a-cath or PICC line. Be sure to tell your Cyberknife nurse and others treating you if you have ever had an allergic reaction to x-ray dye or to shellfish in the past, or if you have any other drug or medication allergies. Tell someone even if you think this information is already in your record. This is your safety.

Treatment Simulation

A Computer Tomography (CT) simulation session is required and is done at the fifth floor of the Shapiro Clinical Center Building. For treatments involving the head or neck areas, the CT simulation therapist will position you on the CT table with a custom-fit flexible plastic mask. For other regions of the body, the CT simulation therapist may position you within a custom-fit body mold. The custom fit mask and body mold are used to maintain you comfortable and still throughout your Cyberknife treatment. 
    Upon completion of your positioning on the CT table a CT scan is done. This CT data is downloaded into the Cyberknife planning computer where your physician and a member of the physics staff will develop your Cyberknife treatment plan. 
    Prior to your CT scan you should not eat or drink anything for three hours. During your CT scan a contrast dye may be used. Again, please be sure to let members of your treatment team know if you have an allergy to dye or to any other substance, even if you think this information is in your chart.
     A nurse will meet you during your CT simulation appointment to give you more information about the process and to answer any questions you may have. The entire CT simulation session should take about two hours.

Treatment Planning

Throughout any treatment planning process the aim is singular; to deliver the dose to the target and spare surrounding structures. The first step in this process is the fusion of diagnostic scans to the CT simulation scan images for the proper delineation of target volume and critical structures. Upon completion of fusion and anatomical delineation a sophisticated treatment plan is optimized by one of the Cyberknife physicists to fulfill your radiation oncologist's dose prescription and clinical objectives. This treatment plan is reviewed by your radiation oncologist prior to treatment. Upon the physician's approval the treatment plan is given to the radiation therapist to administer.

Treatment Day

Your nurse will tell you the day and time of your Cyberknife treatment appointment(s). Please report to the Cyberknife Unit in the Sherman Basement for your treatment. The Sherman Building is on the East Campus of the Beth Israel Deaconess Medical Center, located at 330 Brookline Avenue. Enter through the main Feldberg Lobby and follow the written directions and map given to you by your nurse. If you have difficulty finding the Cyberknife Unit, someone at any of the information desks situated around the medical center can help you.
    Please remember the following on your treatment day(s):

  • There are no restrictions on eating and drinking.
  • Be sure you have someone drive with you to drive you home. We may need to give you a sedative medication; therefore you will not be able to drive home.
  • Please wear comfortable clothes and remove any jewelry.
  • The Cyberknife treatment itself does not cause any pain. However, it is important that you are comfortable during the treatment so that you are able to lie still. If you take pain medication for your condition, it is very important that you take it before your treatment. Also, please bring any pain medicine with you to the hospital in case you need more.
  • While lying on the treatment table you will be fitted with your specific custom mask or body mold made earlier during your CT simulation session.
  • During treatment the Cyberknife robotic arm will move slowly around you to deliver your treatment. The CK robot will not touch you.
  • The amount of time the treatment takes is different with everyone. Most patients are in the CK unit for one to two hours. Feel free to bring a music CD of your choice to listen to during your treatment.

Sometimes, during the treatment planning process your doctor may update your plan based on additional information. This may mean a change in your start date, or a change in the planned number of treatments. If that is to occur, someone from the Cyberknife health care team will notify you.
    Each day of Cyberknife treatment you will meet one of the Cyberknife radiation therapists. The CK radiation therapist will be delivering the prescribed treatment. The CK radiation therapist will position you on the treatment table in the same posture as on the day of your CT simulation and then leave the treatment room. For the safety of family members only the patient is allowed to remain in the treatment room during treatment. The treatment room is equipped with four cameras, a microphone, and speakers. This allows the treating radiation therapist to maintain attention on you, as well on your treatment delivery from the CK treatment console in the adjacent room. At any time during treatment the radiation therapist is available to answer your questions.
    From the CK treatment console the radiation therapist will be taking diagnostic energy x-rays to place you with the Robotic System. Throughout treatment the radiation therapist is taking diagnostic x-ray images to review the level of target motion. At any time the therapist may automatically make small adjustments of the treatment table, or come in the treatment room to make further adjustments. Furthermore, the radiation therapist may come into the treatment room at specific intervals to change the collimator or to check on you. During treatment you will see the Cyberknife's robotic arm go from one treatment position to the next. Upon completion of the daily prescribed fraction the radiation therapist will come into the room to help you off the table.
    Each day one of the CK nurses will be checking your vital signs and review your symptoms, either before or after your treatment. Also, each day one of the radiation oncologists on staff will provide you with an on treatment visit, either before or after treatment.

Followup

On the last day of treatment, one of the Cyberknife nurses will discuss discharge instructions and follow up appointments with you. You will be given a written copy of this information. The nurse will also be glad to address any remaining questions or concerns that you or your family may have about your Cyberknife treatment.