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Treatments
Electronic Brachytherapy
Sometimes referred to as internal therapy, brachytherapy means short distance therapy. The advantage of brachytherapy is the ability to deliver a high dose of radiation to a small area and is useful in situations that require a high dose of radiation or a dose that would be more than normal tissues could tolerate if given by external beam.
The Axxent System, www.xoftinc.com, that we use at our centers is unique to brachytherapy in that it utilizes a disposable miniature X-ray tube (2 mm in diameter) as opposed to a more typical source of radioactive material. This technology has only recently become available and Shields is proud to bring its unique advantages to their patients. The radiation generated with electronic brachytherapy can be controlled in ways that traditional high dose rate brachytherapy can not. Our system is also unique in that it allows for the medical staff to be present in the room during treatment. This is not only clinically advantageous but very comforting for the patient.
The treatment unit consists of a controller, flexible X-Ray source, balloon or GYN applicators and miscellaneous accessories. During treatment the X-ray source is inserted into the central lumen of a balloon for breast radiotherapy or of a GYN applicator for gynecological radiotherapy. As radiation is applied during treatment, the X-ray source is withdrawn back through the applicator at a pre-programmed rate. This feature is designed to ensure the precise application of radiation to the tissue
3D Conformal Therapy
Before a patient's therapy can begin, a team of radiation physicists works with the physicians to develop a treatment plan. This plan is a complex set of instructions which is given to the linear accelerator (radiation producing machine). It is desgined to direct radiation to the cancerous cells while simultaneously protecting healthy tissues and organs.
At Shields Radiation Oncology, treatment plans are developed using a 3-dimensional conformal technique. Using a CT Scan which allows 3-D visualization of the tumor and surrounding normal tissues, as well as a very sophisticated computer system, the physicians and physicists customize the shape of the radiation beams to the tumor's specific size and shape. This plan is then carried out with great precision each day of the patient's treatment.
Intensity Modulated Radiation Therapy (IMRT)
Intensity Modulated Radiation Therapy (IMRT) is a dynamic mode of radiation treatment whereby the radiation beam is carefully sculpted around the patient's anatomy. Compared to conventional radiation therapy, IMRT provides more precise targeting of the tumor and greater sparing of surrounding normal organs. As a result, it allows safe increase in the radiation dose and at the same time, reduction in side effects.
Physicians and physicists work together to create an IMRT plan. They create an extensive list of treatment objectives, and then work with a very advanced computer system to design hundreds of tiny radiation beams. Together these beams produce a high-precision radiation dose pattern in the patient. The treatment itself is carried out with the use of a "multi-leaf collimator" which has many small motorized rods of tungsten that do not allow radiation to penetrate through. These tungsten rods are programmed to move in and out of the radiation beam to deliver strategically shaped beams of radiation that conform to the tumor.
Image Guided Radiation Therapy (IGRT)
Each day when a patient comes in for radiaiton treatment, the part of the body being treated is carefully lined up to the radiation beam. This is usually accomplished with lasers and markings on the outside of the body. In some, instances, there can be an appreciable amount of organ movement inside the patient's body and this can be corrected by the use of IGRT. IGRT is a technique used to track the internal movements of a patient's anatomy by taking digital images of the patient and using them to make fine adjustments to the patient's positioning in real time. In some cases, tiny radio-opaque markers are placed in the patient's body, and their location is used to align the patient for treatment. By following the daily movement of these markers and adjusting the radiaiton beam accordingly, treatment accuracy and precision are enhanced.
PET-CT and MR-CT Fusion
Imaging for radiation therapy has made tremendous advances over the years, and Shields Radiation Oncology brings the very best of what technology has to offer. Patients at Shields Radiation Oncology routinely undergo a Computed Tomography (CT) Scan as part of the treatment planning process. The CT images allow the physician to see most tumors and healthy tissues and are used for treatment design. However, some cancers grow in a way that makes them almost impossible to see on a CT scan, and this is where other imaging modalities come into play.
Positive Emission Tomography (PET) is a nuclear medicine technique that utilizes radioactive glucose injected into the body to image tumors and metastases. Because many cancerous growths take up more of the glucose than their surrounding tissues, they appear as highlighted areas on the scan. Magnetic Resonance Imaging (MRI) is another imaging modality that uses electromagnetic fields to produce very detailed images of a patient's anatomy.
By fusing the PET or MRI to the CT Scan, the advantages of all imaging systems can be fully utilized. This planning procedure can be invaluable in allowing the radiation oncoloigist to know precisely where to direct the radiation. This is yet another measure taken at Shields Radiation Oncology to ensure the highest possible quality in the care of their patients.
Brachytherapy
Prostate brachytherapy is a procedure that involves placing many small radioactive sources, or seeds, into the prostate itself. The radiation dose delivered by these seeds is highly concentrated at the location of the patient's cancer, in their prostate, and is minimal elsewhere. The prostate implant is carried out as an outpatient procedure at one of our affiliated hospitals.
Superficial Therapy
Superficial radiation therapy is a form of skin cancer treatment used for over 100 years. Shields Oncology Services has invested in a modern version of this proven technology. Superficial therapy has a very sharp focus allowing for a small treatment area. Anatomy is preserved which may result in a better cosmetic outcome than surgery, particularly in areas of the face. With out the need of a linear accelerator treatment schedule is convenient, treatments are quick, comfortable and potentially require fewer visits.
Electronic Medical Record
In order to maintain the highest level of accuracy and efficiency at Shields Radiation Oncology, every parameter of a patient's daily treatment is recorded in an electronic medical record, or EMR. This record details everything including the physician's prescription, the designed treatment plan, and the actual treatment delivery. The computer system at Shields Radiation Oncology cross checks all of this information and will not allow the radiation beam to be turned on if any discrepencies are found. The EMR not only provides important quality assurance, but also allows very detailed patient information to be right at the physicians fingertips. EMR contributes greatly to the high quality of care that Shields Radiation Oncology offers.
