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Frequently Asked Questions - Radiation Oncology

 
How do our Physicians determine what treatment is best?
 
The physicians will customize the treatment prescription for each patient in order to provide the best possible treatment for the individual. 3D, IMRT, Stereotactic Radiosurgery, or Brachytherapy, or a combination of all will be considered to allow the doctor to prescribe the amount of Radiation needed to control disease without causing unnecessary side effects.

Historically, the maximum radiation dose that could be given to a tumor has been limited by the sensitivity and limits of the surrounding nearby healthy tissues. The treatment delivery options now available will allow more dose to be delivered to the tumor without increasing the side effects.
 
Who is involved in this delivering Radiation Therapy?
 
In order to prepare for and deliver Radiation treatments we rely on a specially trained team. This team includes the Radiation Oncologists, Medical Radiation Physicists, Medical Dosimetrists, Radiation Therapists, and Radiation Oncology Nurses.
 
What does the Radiation Oncologist do?
 
The radiation oncologist is a specially trained physician, who heads the treatment team. They will prescribe an individualized course of treatment, define the areas to treat, and design the treatment with the help of the other team members. They see our patients at the first visit, each week during treatment, and routinely after treatments are complete to see how the treatment is going, and answer any questions.
 
What does the Medical Radiation Physicist do?
 
The Radiation Physicist will ensure that the treatment plan, computers and radiation delivery system will give the prescribed radiation dose as accurately and precisely as possible. They develop and implement the newest technology to the clinic.
 
What does the Medical Dosimetrist do?
 
The Medical Dosimetrist together with the Radiation Oncologist will design how best to use the treatment machine to deliver the radiation to the tumor while avoiding the healthy tissue. They will also calculate the radiation doses required to meet the Radiation Oncologist's prescription.
 
What does the Radiation Therapist do?
 
The Radiation Therapists see our patients each day to answer any questions and operate the Linear Accelerator (treatment machine).
 
What does the Radiation Oncology Nurse do?
 
The radiation oncology nurse will provide information to patients about the treatment, how to care for themselves, and any possible side effects that they may encounter. They also see our patients each week to see how the treatments are going, and answer your questions.
 
How is the treatment planned?
 
Our patients will have a simulation and CT scan done where the Radiation Oncology team will prepare the patient for treatment by selecting the best position, developing markings to use each day for lining up the treatment machine, and to map out the area of disease. The information will then be transferred into the treatment planning computer. At this time the Radiation Oncologist may wish to combine the CT scan with other scans that have been done such as an MRI or PET studies, to better show the exact shape and position of disease. When this merging of scans ('fusion') is done, the Radiation Oncologist will outline the tumor as a target at which to aim the radiation beam.

Once the target has been identified the Medical Dosimetrist, together with the Radiation Oncologist, will design how best to use the linear accelerator (treatment machine) to deliver the radiation, and calculate the radiation doses required. The radiation treatment is designed so that the treatment area is treated evenly and the normal tissues around it get as little dose as possible. At our facilities this treatment design (or plan) is achieved using the latest available specialized planning computer, and will be achieved by combining several treatment fields coming from different directions to produce a custom shaped treatment.
 
How many treatments are needed?
 
Our Radiation Oncologist will determine exactly how many treatments are needed during the preparation process. Treatments are given daily, and are called fractionated treatments. By giving the treatments in a fractionated manner, the normal healthy tissue that does receive radiation is able to repair and regenerate itself faster than the tumor can, and so receives less damage. Also by fractionating the treatment the radiation is able to hit the tumor cells during different stages of their cell growth cycle, causing more beneficial damage.
 
What kind of radiation is used?
 
The radiation used to deliver Radiation Therapy is generated by a machine called a medical linear accelerator, which makes photons (X-rays). Varian's Linear Accelerator is used to generate the high doses of radiation needed to kill cancer cells. This machine stands approximately nine feet tall, is nearly 15 feet long and can be rotated around our patients with great precision. Operationally, microwave energy, similar to that used in satellite television transmission, is used to accelerate electrons to nearly the speed of light. As they reach maximum speed they collide with a tungsten target, which in turn releases photons, or X-rays. Very small beams with varying intensities can be aimed at a tumor from various angles to attack the target in a complete three-dimensional manner. The idea is to deliver the lowest dose possible to the surrounding tissue, reducing the chance of causing a radiation side effect, while still delivering the maximum dose to the tumor.
 
Does radiation therapy make people radioactive?
 
Many people, when they hear the word "radiation," think immediately of radioactive substances. However, no radioactive substances are involved in the creation of X-rays or electrons by a medical linear accelerator. When a linear accelerator is switched "on," electricity is used to create radiation that is aimed directly at cancer cells. Then, like a flashlight, when the machine is switched off, there is no more radiation. No radiation is "stored" your body. The only time radiation is stored in your body is when Brachytherapy is prescribed.
 
What is the treatment process like?
 
After conducting a physical exam and a medical history review, the radiation oncologist determines an individualized course of treatment for our patients.