Transcript What Happens in the days before treatment ? CT/Simulation Contouring images Treatment planning Radiation Field Design Quality Assurance Iso-center check.

What Happens in the days before
treatment ?
CT/Simulation
Contouring images
Treatment planning
Radiation Field Design
Quality Assurance
Iso-center check
CT/Simulation
A series of detailed images taken of
areas within the body to precisely
locate and mark the target (cancer)
area that is receiving the radiation.
CT/Simulation
•To Ensure that the patient will be in the same position
everyday, the patient’s legs and hips are immobilized.
•A Vac Lock bag is used to immobilize the patient. It is a
bean bag like material that hardens when the air is
sucked out of the bag.
Contouring Images
The images from your CT/Simulation are
downloaded into a treatment planning
program. Then, the important anatomy
in and/or around the radiation therapy
field are outlined.
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•3-D Contouring at the
Dosimetry work station.
Seminal Vesicles
•These contours are used to
determine how the radiation
will be delivered.
•Every person’s anatomy is
unique.
Bladder
Femoral Head
Femoral Head
Prostate
Rectum
Penile Bulb
Rectum
Treatment Planning
This is a process in which the
Physician, Physicist, and Dosimetry staff
work together to optimize delivering the
highest prescription dose to the target
area while minimizing radiation to the
normal anatomy.
Treatment Planning
Collaborative effort of Physician, Physicist,
and Dosimetry Staff
Radiation Field/Beam Design
The radiation fields will be designed according
to the Physician’s prescription with the aid of
the treatment planning system. This 3-D
shaping (modulation) helps
prevent/minimize radiation dose to the
surrounding healthy anatomy.
Radiation Field Design
MLC (Multi Leaf Collimation)
• The Radiation Beam is Shaped (modulated) internally;
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inside the Treatment Machine.
There are hundreds of interlocking lead ‘leaves’ working
together to create one unique dynamic shape altering
the 3-D effect of the radiation beam.
Radiation Field/Beam Manipulation
by
Designing the MLC Pattern
• The design of the MLC pattern is based solely upon the
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patients unique anatomy in correlation to the
physician’s prescription.
As the radiation beam travels through the MLC pattern
the intensity of the beam is shaped (modulated) as it
enters the target area (cancer). Meaning, the target
area (cancer) is receiving the highest prescription
radiation dose and the surrounding healthy anatomy is
receiving the absolute minimum amount of radiation.
Isocenter Check
Isocenter Check (Verification CT Simulation)
Quality Assurance Testing
When the radiation therapy plan is completed, our
physicist will perform a series of QA testing to
ensure that the radiation dose we are delivering to
the patient is exactly what the prescription calls for
prior to the start of treatment.
Isocenter Check
This is a process in which we verify the center
of the radiation field that correlates with the center
of the target (cancer) area receiving radiation. In
addition this confirms that the patient’s position is
accurate. This procedure produces the final
markings of the radiation field. (3 points)
Note: Patient will get 3 permanent tattoo marks the size of a
small freckle.
(One on each hip and the third
Under the belly button.)
Bladder Fill Instructions
• All Patients undergoing Radiation Therapy for Prostate
cancer will be asked to drink 20-24 oz of water 45-60
minutes prior to their appointment time.
• All water is to be consumed within 10 minutes of
beginning to drink. This allows for optimal bladder filling.
• The first week of treatment will determine how well your
body processes the water and the therapists may need
to alter these instructions to better fit the needs of the
patient. Everyone is different. Hydration and kidney
function can also affect the rate of bladder fill.
Importance of the Full Bladder
FULL
BLADDER
Prostate
Radiation Dose Cloud around Prostate
When the bladder is
full it is pushed up
and away from
the prostate. Since
the prostate is the
structure receiving
100% of the
radiation dose, it is
important to limit
the dose to the
Bladder by filling it
up.
Importance of the Full Bladder
• If the Bladder is empty or not full enough
it will lay over the prostate like a deflated
balloon and receive unnecessary amounts
of radiation dose.
The therapy team will evaluate bladder fill everyday before
treatment using ultrasound technology. The therapists will
give feedback on the bladder volume. Unfortunately, if you
are not full enough, you may be asked to drink more water
before treatment occurs.
Clarity Patient Positioning System
The Ultrasound probe is gently
pressed over the abdomen near the
bladder to obtain the images
needed for patient positioning.
Ultrasound Technology
• Is a procedure in which high-energy sound
waves are bounced off internal tissues or organs
and make echoes. The echo patterns are shown
on the screen of an ultrasound machine, forming
a picture of body tissues called a sonogram.
• The full bladder acts as a window to let us
see the Prostate.
• If the bladder is not full enough, it may be
difficult to image the Prostate.
Clarity Ultrasound System
Bladder
Bladder
P Prostate
Prostate
In this image,
the Bladder is
nice and full. It
gives the
Ultrasound
picture a great
deal of contrast.
If it was empty,
everything
would appear as
gray.
Ultrasound IGRT
IGRT (Image Guided Radiation Therapy)
The daily Ultrasound is compared with the original
Ultrasound that was fused with the CT images and
contours acquired with the initial simulation procedure.
The images and contours are then manipulated until
they are perfectly aligned.
This whole process takes only minutes; however, it is
very precise and the reason why we are able to deliver
radiation so accurately.
The Yellow and Red lines are the contours taken from the
original CT scan. As you can see, they are aligned perfectly
over the Ultrasound image.
IGRT Process
This alignment is reproduced daily by the
therapists with much accuracy and then
reviewed by the physician.
The Clarity System will calculate any shifts
required based on the alignment of the
images for the final table coordinates.
The therapists will then move the table to
within the sub-millimeter tolerance that
the Clarity System is calibrated for.
Once these shifts are applied, the patient is
now perfectly aligned and ready for
treatment.
Treatment Day
Treatment Machine
Radiation Therapist work station
What to Expect during Treatment
• You will not feel anything during the treatment
delivery just like when you have an X-ray.
• The therapists can see and hear the patient all
the time they are out of the room.
• We do ask that you lay as still as possible during
your treatment.
***
Note: The Treatment table can be elevated 5 feet off
the ground so never attempt to dismount the table
without the help and direction from a therapist.
Things to Make note
of while undergoing
Radiation Therapy
Nutrition While Undergoing Radiation
• Please eat well balanced meals, and stay well hydrated.
• Do not try to diet or lose weight during treatment.
• It is important that patients try and maintain the
same weight throughout the course of treatment.
• Excessive weight gain or loss may result in re-planning.
Urinary Side Effects
• Frequency ~ going to the restroom more often than normal.
• Urgency ~ finding it difficult to postpone urination.
• Incomplete Emptying of the Bladder ~ a sensation of not
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emptying your bladder completely after you finished
urination.
Intermittency ~ when your stream of urine has stopped and
started again several times.
Weak Stream ~ when your stream of urine is weaker than
normal.
Nocturia ~ getting up to urinate frequently during the
night.
Urinary Irritation ~ burning with urination.
•Note: Some may experience these side effects within 4 weeks of starting
Radiation Therapy. Please tell staff members ASAP if any these occur.
What to do when experiencing urinary side
effects?
• Avoid caffeine and alcohol, these will further irritate
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you bladder
Avoid carbonated beverages
Drink Cranberry Juice
Flomax/Uroxatral/Detrol LA may be prescribed for
urinary frequency
Pyridium my be prescribed for urinary burning
Bowel Side Effects
• Rectal irritation
• Loose stools or diarrhea more frequently
• Hemorrhoid irritation
• Note: Some may experience these side effects within
the first 4 weeks of treatment. Please report this
symptoms to the Staff.
What to do when I experience Bowel
side effects?
• Diet modifications or restrictions: Do not eat fresh
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fruits or vegetables. Stay away from high fiber foods
Daily use of Metamucil or Citrucel
Use Imodium AD on an as needed basis for loose
stools or diarrhea
Anusul HC may be prescribed for hemorrhoid and
rectal irritation
Sexual Side Effects
• Temporary decrease in Sexual interest may occur
• Temporary decrease in erectile function is not unusual
• Permanent decrease in ejaculate or dry ejaculate
• Viagra/Cialis/Levitra may be prescribed to help with these
side effects.
• Sexual activity may be pursued
• Note: Some may experience these side effects within the first
4 weeks of treatment. Please report these symptoms to Dr.
Beat or Heather.
General Side Effects
• Fatigue may occur when nearing the end of
treatment
• Irritation/Redness to the treatment area may occur
but is not likely
• Note: Please report these Symptoms to the Staff.
Scheduling the Treatment Course
• Treatment days are Monday-Friday, no weekends.
• In the event we are closed for a holiday or for an unexpected
circumstance, we will take the days missed and add them to
the end of your treatment.
• It is preferred to have the same appointment time daily, but
arrangements can be made when it is necessary to
accommodate other appointments. Time availability will be
determined by patient volume.
• If you are scheduling travel plans, please let us know ASAP so
that we can anticipate any breaks in your treatment schedule
and plan accordingly.
Thank
You