RADIATION TREATMENT PROCESS


At FROS Radiation Oncology Cyberknife Center our focus is the patient. From the minute you make contact or visit our facility our focus is on the patient and their family.

CyberKnife Treatment | IGRT/IMRT Treatment | High Dose Rate Brachytherapy Treatment


CyberKnife Treatment Process

 

Consultation: Upon your first visit you will meet with our board certified radiation oncologists. You and your family will have your questions answered in a comforting and caring environment. Our CyberKnife cancer treatment team will explain to you the pros and cons of choosing CyberKnife, and they will explain what will happen during your cancer treatment.

Meet Your Medical Coordinator: After completion of the consultation every patient will have a medical coordinator assigned to them to guide them through each step of the Cyberknife process. We understand how difficult this time is for you and your family, so our trained medical coordinators will help you through the entire process. From technical questions on the Cyberknife technology to insurance authorization, our medical coordinators are here for you.

Treatment set-up: This step helps to determine your course of cancer treatment. You will be fitted for a soft, flexible mesh mask or body mold to help minimize movement during your cancer treatment. This is a painless process. Treatment of certain kinds of tumors outside of the head (Prostate, Liver, and Pancreas) may require the insertion of tiny gold markers called fiducials. These will help identify the location of cancer cells. You will then undergo imaging procedures to determine the exact location, size and shape of your tumor. The process begins with a standard high-resolution computerized tomography (CT) scan. For certain tumors, other imaging techniques, such as molecular resonance imaging (MRI), angiography or positron emission tomography (PET) may also be used. All exams will be scheduled for you through your personal medical coordinator.

Treatment planning: Your cancer treatment team inputs your tumor information into advanced CyberKnife software that calculates the number, direction and intensity of radiation beams that will be used during your cancer treatment. The CyberKnife develops a treatment plan that is specific to your unique tumor. You do not need to be present during this step. Your doctor will communicate with you about your cancer treatment plan.

Treatment delivery: Be sure to wear comfortable clothes and no jewelry the day of your appointment. Feel free to bring your own music with you to enjoy during your cancer treatment. Make sure you bring someone to drive you home, as we may give you a mild sedative to make you more comfortable. During your treatment you will lie comfortably on a treatment table, which automatically positions you. We will help position you on the table and secure your flexible mesh mask/body mold. Because the cancer treatment is painless, you will be awake throughout your entire procedure, which usually lasts anywhere from 30-90 minutes, depending on the complexity of the tumor. After your procedure, you are free to go home. Depending on the course of cancer treatment, you may have to return for more sessions. Most patients have anywhere from one to five sessions with CyberKnife.

Follow-up: After your cancer treatment, your doctor will review follow-up imaging or other tests to assess the tumor's response to the delivered radiation and measure your progress.



IGRT/IMRT Treatment Process

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Consultation: Upon your first visit you will meet with our board certified radiation oncologists. You and your family will have your questions answered in a comforting and caring environment. Our cancer treatment team will explain to you the pros and cons of choosing IMRT/IGRT, and they will explain what will happen during your cancer treatment.

Meet Your Medical Coordinator: After completion of the consultation every patient will have a medical coordinator assigned to them to guide them through each step of the IMRT/IGRT treatment process. We understand how difficult this time is for you and your family, so our trained medical coordinators will help you through the entire process. From questions on the technology to insurance authorization, our medical coordinators are here for you.

Pre-Simulation Procedures: The following steps may be performed before the CT simulation

1. Scans or blood work to see if there is any other metastasis. However it is often not necessary to order further scans.

2. For Prostate Cancer patients: Placement of gold markers to facilitate IGRT/ IMRT – by placing the “fiducial” gold-markers into the prostate using an ultrasound, this helps to locate the precise location of the organ on a daily basis.

Simulation: Prior to the radiation treatment, a Computed Tomography (CT) simulation will be performed. It is part of the “Planning Session”. All the necessary information that the radiation oncologist needs to create an individualized course of radiation is gathered. This helps the oncologists and physicists to design a customized treatment plan that matches your internal and external anatomy.

The Simulation typically lasts for 30-60 minutes. During the painless process, measurements of your body are taken and a scan of the region of treatment is taken. A body mold or mesh mask is customized to each patient before scanning begins for immobilization purposes and small ink marks may be placed on your skin to aid in daily set-up reproducibility.

After the simulation, our therapists will help you arrange your future treatment appointments, taking into consideration the timeframe that you most prefer.

Treatment Planning: The next step is the most important. Once we have your anatomy (images from the CT simulation) on the computer, data will then be reviewed by the Radiation Oncologist with the aid of our New York State Licensed PhD Physicists. Using sophisticated software, the shape and angles of the radiation beams are optimized. In the next few days after your CT simulation, a dosimetric Intensity Modulated Radiation Therapy (IMRT) or Image-Guided Radiation Therapy (IGRT) plan will be created based on a precise radiation treatment model which makes sure most of the radiation goes to those areas that need to receive treatment.

Every plan that is done at FROS is reviewed by at least two of our PhD Physicists, Radiation Oncologist and licensed Radiation Therapist to assure the Quality of the treatment plan. A QA test is done for each plan that assures the amount of dose is being given to the correct area.

Treatment Verification: After radiation oncologist and physics team created a perfect modeled treatment plan for you, the oncologist will meet with you again. He will specify the number of treatments, risks and side effects and what daily activity patient should continue or avoid during this period. Your consent/agreement with the radiation oncologist is needed to start the treatment. After you sign the consent, our medical coordinator will escort you to a therapist team and your first treatment will begin.

Our Licensed Radiation Therapists will verify the area we are treating by taking orthogonal images to assure the area we are treating is accurate. Our Radiation Oncologists will verify these images are correct before treatment begins.

Daily Treatments: The radiation oncology department works from Monday to Friday. The entire IMRT / IGRT treatment lasts from 10 to 15 minutes depending on the treatment plan complexity. Please arrive 10-15 minutes earlier for the treatment. The therapist will escort you into the treatment room and will make sure you are exactly in the same position as you were in the CT simulation by setting up the Immobilization devices and using the marks on your skin.

The therapist will monitor the treatment outside the room. Treatment will be stopped immediately if any emergency happens. During the treatment Cutting edge radiation technologies are utilized for further precision. As in the IGRT treatment, On-Board Imaging, Cone-Beam CT will help to find the exact and precise location of the targeted region. You won’t feel any pain or discomfort when the treatment is on.

On-Treatment Visits: On your first day and even first few weeks of treatment, you are likely to be without any side effects. If any side effects occur and raise your concern, you may contact your radiation oncologist immediately through the medical coordinator assigned to your case. You will see the radiation oncologist and nurse for weekly status checks. If medication is necessary for any possible side effects, our radiation oncologist will prescribe it or modify your treatment process. Also during the course of treatment, the therapist team will report your current treatment status to the radiation oncologist for the treatment plan adjusting.

Regular Follow-Ups: Once radiation therapy is completed, our office staff will make you the follow-up appointments with the radiation oncologist. Typically, you will be seen back in our offices one month following completion of treatment, then in 3months, 6months and 1 year. During these follow-up visits, assessment of your response to treatment and disease status is reviewed. In addition, if any tests were performed from another facility it will be requested upon follow up to be reviewed by the radiation oncologist. Within this period, please feel free to contact the medical coordinator and physicians about any request or questions concerning to your health.



High Dose Rate Brachytherapy Treatment Process

 

Consultation: Upon your first visit you will meet with our board certified radiation oncologists. You and your family will have your questions answered in a comforting and caring environment. Our cancer treatment team will explain to you the pros and cons of choosing High Dose Rate Brachytherapy, and they will explain what will happen during your cancer treatment.

Meet Your Medical Coordinator: After completion of the consultation every patient will have a medical coordinator assigned to them to guide them through each step of the High Dose Rate Brachythrapy process. We understand how difficult this time is for you and your family, so our trained medical coordinators will help you through the entire process. From technical questions on the technology to insurance authorization, our medical coordinators are here for you.

Treatment Day

Step 1: Implant placement
FROS Radiation Oncology physicians decide which type of implant the patient requires, based on location, tumor extent and other factors. The three types are:

1. Intracavitary Implant: an applicator is inserted into a body cavity to reach the tumor. Intracavitary implants are performed on an out-patient basis. Local anesthesia and/or conscious sedation are all that is required.
2. Intraluminal Implant: the catheters are inserted into a "tube" structure such as the bronchus, esophagus, or bile duct. These are treated the same as intracavitary implants on an outpatient basis.
3. Accuboost Breast Treatment

Step 2: Simulation
After the implant has been placed, a CT is taken by the radiation therapists to determine the exact location of the implant in the body and the relationship to adjacent organs. The therapists' expertises in taking these images assure that the implant and nearby organs are visualized clearly. The physician reviews these films and makes final adjustments to the implant if necessary.

Step 3: Dosimetry
The CT images are given to our highly trained Physics team to enter into the treatment planning computer. The computer does the initial calculation but it is the Licensed Physicist who "fine tunes" or customizes the radiation doses to conform to the target volume while minimizing the doses to the nearby normal tissues. After the treatment plan has been approved by the physician, the computer transfers the treatment plan instructions to the HDR remote afterloader.

Step 4: Treatment
The patient is moved into the brachytherapy treatment room. The ends of the applicator or treatment catheters that protrude outside the body are connected to "transfer" tubes which are then connected to the afterloader. The programmed instructions tell the afterloader where to direct the source and how long the source will stay in each dwell position. The patient is alone in the treatment room while the treatment is being given, but the therapists, radiation oncologist and physicists are continually monitoring the patient through an intercom and closed circuit TV monitors. The entire treatment process takes about 30-90 minutes depending on the size and complexity of the implant and the activity of the source. When the treatment is completed, the radiation source is retracted back into the HDR afterloader. There is no radiation left behind in the patient.

Step 5: Implant Removal
After the treatment(s) have been given, the implant is removed. Intracavitary, intraluminal and Accuboost applicators are simple to remove and the patient goes home soon after removal. With interstitial implants, sutures holding the template and/or catheters in place are clipped and the implant is gently removed.

Step 6: Follow-up
After your cancer treatment, your doctor will review follow-up imaging or other tests to assess the tumor's response to the delivered radiation and measure your progress.

IN THE NEWS

August 28, 2013

June 1, 2013

FROS attending physicians, Alan Katz and Josephine Kang, to give an oral presentation at this year's ASTRO meeting on long term outcomes after stereotactic body radiation therapy (SBRT) for prostate cancer.

VIDEOS

The Redefining Radiosurgery Video gives definitive clinical, hospital and patient benefits as compared to other radiation therapy and systems.

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LOCATIONS

Flushing: 40-22 Main St, 4th Fl,
Flushing, NY 11354
Brooklyn: 1737 Bath Ave
Brooklyn, NY 11214
Manhattan: 47 Essex St.
New York, NY 10002

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