CyberKnife Treatment Process | IGRT/IMRT Treatment Process | Accuboost Treatment Process

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, as well as what will happen during the 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


Consultation: After being referred to Flushing Radiation Oncology or upon request for a consultation, our office staff will help you arrange a consultation appointment with our radiation oncologist at one of our facilities. You may arrive earlier with your health insurance card and all medical records. For the registration, patient information and signature are required; a photo will be taken for security and identification reasons.
One of our clinical staff will give you an initial physical examination before your consultation. Then, one of our radiation oncologists will review your current case and health history in the consultation and if necessary there will also be another physical examination. If radiation therapy is a treatment option for your particular situation and stage of disease, we will discuss the details of this treatment, including how many treatments will be prescribed, side effects, and risks and benefits. You will have an opportunity to ask any questions you have or talk about your concerns.

Meet Your Medical Coordinator: After completion of the consultation you will have a medical coordinator assigned to you. They will assist you through each step of the treatment. They will help you check the radiation benefits from your health insurance company, get the authorization for your treatment if necessary, schedule the CT simulation, call for the transportation and answer any questions concerning the treatment.

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 used at FROS is reviewed by at least two of our PhD physicists, a radiation oncologist and a licensed radiation therapist, to assure the quality of the treatment plan. A Quality Assurance test is done for each plan that assures the amount of dose is being given to the correct area.

Treatment Verification: After a radiation oncologist and the physicists create a perfect modeled treatment plan for you, the oncologist will meet with you again. He will specify the number of treatments and risks and side effects, as well as what daily activity the 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 that we are targeting the correct region by taking orthogonal images to assure the area we are treating is accurate. Our radiation oncologists will then 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 early to 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 occurs. 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 while the treatment is occurring.

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. Regardless, 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 3 months, 6 months, 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.

Accuboost Treatment Process



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.


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



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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