There are many ways to deliver and target radiation into the body. As with other modalities, radiation delivery techniques give the physician more choices as to how best to treat the cancer. Depending on the type of cancer and stage, one or more methods may be used to maximize tumor reduction and minimize damage to normal healthy tissues. Radiation can be used as part of a multi-disciplinary approach including chemotherapy and / or surgery as well as a standalone treatment for certain tumors.
CT Scanning is used to map the organs and structures within the body. When a treatment plan is developed, a CT Simulation is necessary to acquire measurements and other technical data. The patient is positioned on the CT scanner table where multiple scans are performed to generate a digital 3D reconstruction of the body and tumor area. The information collected during simulation helps the radiation oncologist and other staff members prepare and deliver the radiation.
Image fusion is a common term used within medical diagnostics and treatment. The term is used when multiple patient images are registered and overlaid or merged to provide additional information. Fused images may be created from multiple images from the same imaging modality, or by combining information from multiple modalities, such as magnetic resonance image (MRI), computed tomography (CT), positron emission tomography (PET), and single photon emission computed tomography (SPECT). In radiation oncology, these images serve different purposes. For example, CT images are used more often to ascertain differences in tissue density while MRI images are typically used to diagnose brain tumors.
3D Conformal Therapy allows us to shape the radiation beam around the tumor and control the dose of radiation throughout the process to limit exposure to normal healthy tissues. 3D Conformal treatment involves the use of CT images (computed tomography) to construct a 3-dimensional, computer-generated recreation of the internal organs and the tumor. This allows the radiation oncologist to target the treatment area while minimizing side effects.
Intensity Modulated Radiation Therapy IMRT involves the use of multiple high-energy x-ray beams to target the tumor. The radiation beams are calculated in advance as part of a patient specific treatment plan to deliver precise radiation while minimizing the dose to the normal surrounding tissues. The strength of the beams can be adjusted as necessary depending on the size, location and stage of the cancer.
Image Guided Radiation Therapy IGRT is radiation treatment supported by enhanced graphic targeting. By mapping and targeting the treatment area using 2 and 3-D imagery, we can achieve better patient outcomes with fewer side effects. Clinicians need the best possible image information to make fast accurate decisions when comparing reference images to set-up images prior to treatment. To achieve this CBCC utilizes the Varian On Board Imaging (OBI) kV system which delivers improved tumor targeting using high resolution, low dose digital imaging in the treatment room. A choice of imaging modalities is available on the system, including 2D radiographic, fluoroscopic, or 3D cone-beam CT imaging. The use of kV imaging can result in lower patient dose and better image quality than megavoltage imaging. This is particularly useful when addressing prostate, breast, lung, spine head/neck cancers and other sites in the body. Our clinicians can retarget the treatment area daily to overcome any movement of internal organs as well as the size and shape of the cancer site. This information is the basis for key decision making: whether to continue treatment as is or change course. Our highly skilled technicians can confidently manage patients and target movement—both before and during treatments.
RapidArc® is a volumetric arc therapy that delivers a precisely sculpted 3D dose distribution with a single 360-degree gantry rotation. By using an advanced algorithm that simultaneously changes the rotation speed of the gantry, shape of the treatment aperture and the delivery dose rate, treatments are delivered in less than 2 minutes in most cases. Volumetric modulated arc therapy differs from existing techniques like helical IMRT or intensity-modulated arc therapy (IMAT) because it delivers dose to the whole volume, rather than slice by slice.
High Dose Rate Brachytherapy (HDR) utilizes radioactive materials that are placed temporarily inside cancerous tumors or areas of the body requiring radiation treatment. These implants can be done with high intensity sources that oscillate the radiation then are removed within minutes. A special machine located in the treatment room delivers the radiation. It can be used to treat prostate, breast, gynecological, lung and some head and neck cancers, but is rarely the only radiation treatment prescribed.
Seed Implant Brachytherapy involves the use of tiny radioactive isotopes called "seeds" that are permanently placed in the body. This form of treatment controls the dose and reduces exposure to the normal healthy tissues that surround the tumor. The relative amount of radiation is very low and over time implanted seeds lose their radioactivity and can remain in the body. In the early stages of prostate cancer for example, seed implantation is often used as a standalone treatment.
The CyberKnife Robotic Radiosurgery System is a non-invasive alternative to surgery for the treatment of both cancerous and non-cancerous tumors anywhere in the body, including the prostate, lung, brain, spine, liver, pancreas and kidney. The treatment – which delivers beams of high dose radiation to tumors with extreme accuracy – offers new hope to patients worldwide.
Though its name may conjure images of scalpels and surgery, the CyberKnife treatment involves no cutting. In fact, the CyberKnife System is the world's first and only robotic radiosurgery system designed to treat tumors throughout the body non-invasively. It provides a pain-free, non-surgical option for patients who have inoperable or surgically complex tumors, or who may be looking for an alternative to surgery.
Accelerated Partial-Breast Irradiation (APBI) is a newer treatment alternative for women with breast cancer. It works by delivering radiation from inside the lumpectomy cavity (the space left after the tumor is removed). It is delivered on an outpatient basis twice a day usually for 5 days. A small device is placed into the cavity that is connected to a catheter. During radiation therapy, the catheter is connected to a computer-controlled radiation delivery machine. When completed, the machine and catheter are disconnected leaving no radiation between treatments or after the final treatment.
Studies have shown that receiving radiation to the breast while lying in the prone, or face down, position has many benefits to women, while delivery the same quality outcomes as the traditional supine position, where women lay flat on their back for radiation treatment. Prone breast radiation therapy is a unique approach to treating breast cancer. Radiation is administered on a specially-designed table with a breast board to help women more comfortably lay in the prone position on her stomach with the breast away from the body for radiation therapy. The healthy breast is kept close to the body, isolating the area for treatment. With the breast, away from the body during radiation in the prone position, radiation exposure to the surrounding organs and tissues, such as the heart and lungs, is minimized. This lowers the risk of complications, such as future heart disease, lung damage and poor cosmetics.