RADIATION TREATMENT PROCESS
CyberKnife Treatment Process
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.
Consultation: After being referred to Flushing Radiation Oncology or when 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 reason.
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 be a physical examination. If radiation therapy is a treatment option for your particular situation and stage of disease, the details of this treatment including how many treatments will be prescribed, as well as side effects, risks and benefits. You will have an opportunity to ask any questions 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, if necessary they will get the authorization for your treatment, schedule the CT simulation, call for the transportation and answer any questions concerning with 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 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 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 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.