Radiation Oncology

Radiation oncologist physicians are board certified specialists who prescribe radiation treatment for cancer. Radiation oncologists work closely with other physicians, physicists, nurses, dosimetrists and radiation therapists as part of a large, multidisciplinary team.

A radiation oncology physicist is trained in physics and also in clinical, medical and radiological sciences. Working alongside the radiation oncologist, and other team members, the physicist’s chief responsibility is to ensure safe, accurate and effective delivery of radiation as a result of prescribed treatment.

A dosimetrist custom designs radiation therapy treatment plans, utilizing technical knowledge of radiation oncology treatment machines and equipment. A dosimetrist is educated in radiation therapy treatments and procedures and has expertise necessary to direct radiation beams to their exact target using the prescribed dose and avoiding damage to surrounding tissues. A dosimetrist works closely with the radiation oncologists and physicists to implement a plan.

Radiation therapists are involved in many aspects of treatment including patient communication, assessment, monitoring and overall general care. Working under the guidance of a radiation oncologist, a radiation therapist ensures quality, regarding all aspects of radiation delivery. Remaining sensitive to the patient’s needs, they work to ensure proper set-up and administration of treatment by imaging the targeted treatment area and reproducing the patient positioning and plan specifications, on a daily basis.

Radiation oncology nursing is a distinct area of practice, requiring knowledge in radiation therapy and the ability to support the psychological and physical needs of the cancer patient, including monitoring physical and emotional status, reviewing health history, tracking lab results and imaging studies, safely administering medications, collaborating with doctors and clinicians, helping patients to understand the disease, treatment plan and side effects, translating complex medical terminology, and much more. 

Left-Sided Breast Cancer
Studies have shown that patients treated for cancers of the left breast may receive significant radiation dose to their heart.  We offer two different options for our patients to avoid radiation delivery to the heart.

Prone Positioning
With prone positioning, radiation is administered on a specially designed table, using a cushioned breast board to help a patient lay comfortably on their stomach. The radiation dose delivered to the breast in prone position is the same as with standard supine treatment, however the prone position avoids radiation exposure to critical structures such as the heart and lungs. Prone positioning may also ensure a more even distribution of radiation for patients with pendulous breasts.

Breath Hold Techniques
Breath hold techniques can significantly lower the amount of radiation dose to your heart and lungs. This technique requires a patient to hold their breath for 20 to 30 seconds during treatments. This technique has been found to be advantageous over free breathing because the radiation beam is turned on only when the breast has moved away from the underlying heart.

Treatment Duration Information
Most patients will be treated to their whole breast with a typical treatment course of 6-7 weeks. Many women are eligible for accelerated treatment courses consisting of 3-4 weeks. Your radiation oncologist will offer this to you if you are eligible. These treatments would be focused only to the region of the breast where the tumor is and not to the whole breast. Your radiation oncologist will discuss these options with you at the time of your consultation.

RapidArc Technology
RapidArc technology increases the level of precise delivery and beam targeting by combining a variety of sophisticated technologies and angled beams for a treatment that significantly reduces treatment times and radiation exposure for the patient. During the RapidArc treatment, the machine will continuously rotate around a patient’s body, allowing for precise delivery of radiation from any angle. Each Arc takes 1-2 minutes. Depending on the complexity of the treatment, there will typically be between 1-3 arcs utilized.

Intensity Modulated Radiation Therapy (IMRT)
IMRT is the name of the technique that allows for direct, highly focused radiation that is delivered from numerous different angles. By doing so, it conforms the radiation treatment beam to the exact size and shape of the cancerous tumor and modifies the intensity of that beam to deliver the greatest dose directly to the tumor, while sparing surrounding healthy tissue.

IMRT treatment plans are designed to focus the radiation at the prostate while minimizing radiation exposure of the bladder, rectum and small bowel.

Image Guided Radiation Therapy (IGRT)
IGRT allows us to confirm that our planned radiation beams align to the contours of the patient’s tumor. Using CT, ultrasound and various guidance systems, more precise doses can be administered, ensuring the natural movement of the body part does not adversely affect treatment. The most common IGRT technique consists of a “Cone Beam CT scan”. Our machine will take a CT scan of the treatment region just before each treatment, confirming that the anatomy aligns perfectly as planned. When necessary, this imaging is repeated mid-treatment, to ensure no motion has occurred during the radiation session.

Treatment Duration Information
A standard radiation course will be approximately 8 weeks.  For some patients, a more rapid course of radiation may be prescribed.  This treatment is called hypofractionation, and delivers the same effective dose of radiation over a shorter time, usually six weeks.  Stereotactic body radiation may also be an option, which delivers high doses in five fractions, usually delivered over about two weeks, as part of a clinical trial.  Your care team will discuss with you which is the best treatment for you.

RapidArc Technology
RapidArc technology increases the level of precise delivery and beam targeting by combining a variety of sophisticated technologies and angled beams for a treatment that significantly reduces treatment times and radiation exposure for the patient. During the RapidArc treatment, the machine will continuously rotate around a patient’s body, allowing for precise delivery of radiation from any angle. Each Arc takes 1-2 minutes. Depending on the complexity of the treatment, there will typically be between 1-3 arcs utilized.

Intensity Modulated Radiation Therapy (IMRT)
IMRT is the name of the technique that allows for direct, highly focused radiation that is delivered from numerous different angles. By doing so, it conforms the radiation treatment beam to the exact size and shape of the cancerous tumor and modifies the intensity of that beam to deliver the greatest dose directly to the tumor, while sparing surrounding healthy tissue. It may be utilized to spare the bladder and small bowel while focusing the radiation beams on the rectal tumor and associated lymph nodes.

Image Guided Radiation Therapy (IGRT)
IGRT allows us to confirm that our planned radiation beams align to the contours of the patient’s tumor. Using CT, ultrasound and various guidance systems, more precise doses can be administered, ensuring the natural movement of the body part does not adversely affect treatment. The most common IGRT technique consists of a “Cone Beam CT scan”. Our machine will take a CT scan of the treatment region just before each treatment, confirming that the anatomy aligns perfectly as planned. When necessary, this imaging is repeated mid-treatment, to ensure no motion has occurred during the radiation session.

Treatment Duration Information
A standard radiation course will be approximately 5-6 weeks.

Intensity Modulated Radiation Therapy (IMRT)
IMRT is the name of the technique that allows for direct, highly focused radiation that is delivered from numerous different angles. By doing so, it conforms the radiation treatment beam to the exact size and shape of the cancerous tumor and modifies the intensity of that beam to deliver the greatest dose directly to the tumor, while sparing surrounding healthy tissue. It is used to direct the radiation beam at the pancreas while minimizing the radiation exposure to the stomach, liver, small bowel, and kidneys.

Image Guided Radiation Therapy (IGRT)
IGRT allows us to confirm that our planned radiation beams align to the contours of the patient’s tumor. Using CT, ultrasound and various guidance systems, more precise doses can be administered, ensuring the natural movement of the body part does not adversely affect treatment. The most common IGRT technique consists of a “Cone Beam CT scan”. Our machine will take a CT scan of the treatment region just before each treatment, confirming that the anatomy aligns perfectly as planned. When necessary, this imaging is repeated mid-treatment, to ensure no motion has occurred during the radiation session.

RapidArc Technology
RapidArc technology increases the level of precise delivery and beam targeting by combining a variety of sophisticated technologies and angled beams for a treatment that significantly reduces treatment times and radiation exposure for the patient. During the RapidArc treatment, the machine will continuously rotate around a patient’s body, allowing for precise delivery of radiation from any angle. Each Arc takes 1-2 minutes. Depending on the complexity of the treatment, there will typically be between 1-3 arcs utilized.

Respiratory Gating
Respiratory gating techniques use external devices to predict and monitor the phase of the breathing cycle while the patient breathes freely, with the purpose of limiting radiation exposure to healthy organs. During respiratory gating, the radiation beam is turned on only during certain parts of the breathing cycle.  Since your internal organs are often moving significantly during normal breathing, this technique may be utilized to account for this motion and ensure accurate direction of the radiation beams to the tumor.

Treatment Duration Information
A standard radiation course will be approximately 5-6 weeks. Your doctor may discuss treatment over 2 weeks as well.

Intensity Modulated Radiation Therapy (IMRT)
IMRT is the name of the technique that allows for direct, highly focused radiation that is delivered from numerous different angles. By doing so, it conforms the radiation treatment beam to the exact size and shape of the cancerous tumor and modifies the intensity of that beam to deliver the greatest dose directly to the tumor, while sparing surrounding healthy tissue. It is used to deliver focused a focused radiation beam and the esophagus and lymph nodes while minimizing radiation exposure of the heart and healthy lung tissue.

Image Guided Radiation Therapy (IGRT)
IGRT allows us to confirm that our planned radiation beams align to the contours of the patient’s tumor. Using CT, ultrasound and various guidance systems, more precise doses can be administered, ensuring the natural movement of the body part does not adversely affect treatment. The most common IGRT technique consists of a “Cone Beam CT scan”. Our machine will take a CT scan of the treatment region just before each treatment, confirming that the anatomy aligns perfectly as planned. When necessary, this imaging is repeated mid-treatment, to ensure no motion has occurred during the radiation session.

RapidArc Technology
RapidArc technology increases the level of precise delivery and beam targeting by combining a variety of sophisticated technologies and angled beams for a treatment that significantly reduces treatment times and radiation exposure for the patient. During the RapidArc treatment, the machine will continuously rotate around a patient’s body, allowing for precise delivery of radiation from any angle. Each Arc takes 1-2 minutes. Depending on the complexity of the treatment, there will typically be between 1-3 arcs utilized.

Respiratory Gating
Respiratory gating techniques use external devices to predict and monitor the phase of the breathing cycle while the patient breathes freely, with the purpose of limiting radiation exposure to healthy organs. During respiratory gating, the radiation beam is turned on only during certain parts of the breathing cycle.  Since your internal organs are often moving significantly during normal breathing, this technique may be utilized to account for this motion and ensure accurate direction of the radiation beams at the tumor at all times.

Treatment Duration Information
A standard radiation course will be approximately 5-6 weeks.

Intensity Modulated Radiation Therapy (IMRT)
IMRT is the name of the technique that allows for direct, highly focused radiation that is delivered from numerous different angles. By doing so, it conforms the radiation treatment beam to the exact size and shape of the cancerous tumor and modifies the intensity of that beam to deliver the greatest dose directly to the tumor, while sparing surrounding healthy tissue.

IMRT treatment plans are designed to focus the radiation at the cervix and/or uterus (or if the uterus was removed, the region where the uterus was located previously) while minimizing radiation exposure of the bladder, rectum and small bowel.

Image Guided Radiation Therapy (IGRT)
IGRT allows us to confirm that our planned radiation beams align to the contours of the patient’s tumor. Using CT, ultrasound and various guidance systems, more precise doses can be administered, ensuring the natural movement of the body part does not adversely affect treatment. The most common IGRT technique consists of a “Cone Beam CT scan”. Our machine will take a CT scan of the treatment region just before each treatment, confirming that the anatomy aligns perfectly as planned. When necessary, this imaging is repeated mid-treatment, to ensure no motion has occurred during the radiation session.

RapidArc Technology
RapidArc technology increases the level of precise delivery and beam targeting by combining a variety of sophisticated technologies and angled beams for a treatment that significantly reduces treatment times and radiation exposure for the patient. During the RapidArc treatment, the machine will continuously rotate around a patient’s body, allowing for precise delivery of radiation from any angle. Each Arc takes 1-2 minutes. Depending on the complexity of the treatment, there will typically be between 1-3 arcs utilized.

Brachytherapy
Brachytherapy can be used to treat cervical and endometrial cancer, working to deliver radiation from the inside of your body instead of from the outside. The brachytherapy method delivers radiation to tumors by placing radioactive sources within or immediately next to tumor tissue. High dose rate brachytherapy is given over the course of several minutes, with the entire procedure typically taking a few hours.

Treatment Duration Information
A standard radiation course will be approximately 5-6 weeks with external radiation and this is followed by high dose rate brachytherapy, consisting of five additional treatments delivered over a two-and-a-half-week period.

Intensity Modulated Radiation Therapy (IMRT)
IMRT is the name of the technique that allows for direct, highly focused radiation that is delivered from numerous different angles. By doing so, it conforms the radiation treatment beam to the exact size and shape of the cancerous tumor and modifies the intensity of that beam to deliver the greatest dose directly to the tumor, while sparing surrounding healthy tissue.

IMRT treatment plans are designed to focus the radiation at the tumor and/or cancerous lymph nodes while sparing the normal lung, heart, and esophagus.

Image Guided Radiation Therapy (IGRT)
IGRT allows us to confirm that our planned radiation beams align to the contours of the patient’s tumor. Using CT, ultrasound and various guidance systems, more precise doses can be administered, ensuring the natural movement of the body part does not adversely affect treatment. The most common IGRT technique consists of a “Cone Beam CT scan”. Our machine will take a CT scan of the treatment region just before each treatment, confirming that the anatomy aligns perfectly as planned. When necessary, this imaging is repeated mid-treatment, to ensure no motion has occurred during the radiation session.

RapidArc Technology
RapidArc technology increases the level of precise delivery and beam targeting by combining a variety of sophisticated technologies and angled beams for a treatment that significantly reduces treatment times and radiation exposure for the patient. During the RapidArc treatment, the machine will continuously rotate around a patient’s body, allowing for precise delivery of radiation from any angle. Each Arc takes 1-2 minutes. Depending on the complexity of the treatment, there will typically be between 1-3 arcs utilized.

Respiratory Gating
Respiratory gating techniques use external devices to predict and monitor the phase of the breathing cycle while the patient breathes freely, with the purpose of limiting radiation exposure to healthy organs. During respiratory gating, the radiation beam is turned on only during certain parts of the breathing cycle.  Since your internal organs are often moving significantly during normal breathing, this technique may be utilized to account for this motion and ensure accurate direction of the radiation beams to the tumor.

Treatment Duration Information
A standard radiation course will be approximately 6 weeks.

Stereotactic Body Radiation Therapy (SBRT)
SBRT is used for certain non-small cell lung cancers. SBRT is a uniquely designed coordinate system used for direct targeting of tumors in the body, to achieve limited but highly precise treatment doses. Many studies have found these treatments to be highly effective in curing lung cancer when surgery is not feasible. Patients who have localized lung cancer without spread to adjacent lymph nodes and are not candidates for curative surgery (lobectomy) may be a candidate for these treatments.

SBRT Treatment Duration Information
Standard SBRT lung treatments consist of between one and five treatments.  Sometimes the tumor size, shape or location mandate longer courses of treatment and therefore SBRT lung treatments may require up to ten treatments of very high dose radiation targeted at the lung tumor. 

PET/CT simulation is a recommended medical imaging technique for treating head and neck cancer based on its advantage of being able to define the disease, nodal status and distant metastases.

Intensity Modulated Radiation Therapy (IMRT)
IMRT is the name of the technique that allows for direct, highly focused radiation that is delivered from numerous different angles. By doing so, it conforms the radiation treatment beam to the exact size and shape of the cancerous tumor and modifies the intensity of that beam to deliver the greatest dose directly to the tumor, while sparing surrounding healthy tissue.

IMRT treatment plans are designed to focus the radiation at the tumor and/or cancerous lymph nodes while sparing the many adjacent normal structures, such as the salivary glands, oral cavity, swallowing muscles etcetera

Image Guided Radiation Therapy (IGRT)
IGRT allows us to confirm that our planned radiation beams align to the contours of the patient’s tumor. Using CT, ultrasound and various guidance systems, more precise doses can be administered, ensuring the natural movement of the body part does not adversely affect treatment. The most common IGRT technique consists of a “Cone Beam CT scan”. Our machine will take a CT scan of the treatment region just before each treatment, confirming that the anatomy aligns perfectly as planned. When necessary, this imaging is repeated mid-treatment, to ensure no motion has occurred during the radiation session.

Treatment Duration Information
A standard radiation course will be approximately 7 weeks.

HDR Brachytherapy
Skin HDR Brachytherapy is a radiotherapy technique performed for certain types of skin cancers. It provides effective treatment with minimal side effects for patients who cannot be treated surgically or for whom the cosmetic results may be superior with radiation. HDR Brachytherapy allows for a dose reduction to surrounding healthy tissue, producing positive functional and cosmetic results.

Radiation therapy is commonly used to relieve pain/symptoms associated with bone metastases and/or brain metastases. These treatments are most often delivered in 10 sessions or less and are highly effective in reducing patient discomfort.

Stereotactic Radiosurgery (SRS)
SRS is a technique whereby an extremely high dose of radiation is targeted at the involved tumor in a single session. These treatments are often offered for limited brain metastases as well as select spine metastases. These treatments are often designed to utilize IMRT, IGRT and/or RapidArc as part of the treatment delivery process.

For patients with limited brain metastases, SRS has shown to be highly effective in controlling the treated lesion and sparing patients from the potential side effects of whole brain radiation. After treatment is completed, patients will continue to undergo surveillance imaging of the brain to ensure that the treated lesion(s) are under control and that no new lesions have arisen. 

For patients with isolated bony metastases, particularly with certain tumor types historically resistant to radiation, they may be candidates for radiosurgery (select spinal lesions) or for stereotactic body radiotherapy delivered in five treatments or less. These treatments utilize the similar sophisticated treatments that are offered in the brain. They have been reported to be associated with durable control and pain relief.

For patients with oligometastatic disease (metastatic disease limited to one or only a few locations), they may also be candidates for focused stereotactic radiation treatments at the isolated regions resistant to chemotherapy. This is an area of active clinical research, but some studies have suggested that in select cases these treatments lead to improved control of the cancer and might prolong survival. Should you have any questions you should discuss this with your radiation oncologist and/or medical oncologist.