The radiation oncology department at the Charles W. Christie Cancer Center is accredited by the American College of Radiation Oncology. This accreditation is granted only after a detailed, exhaustive evaluation of all aspects of the department by the American College of Radiation Oncology, the oldest national accreditation organization for radiation oncology. It certifies that the department’s physician, personnel, equipment, treatment planning, and quality assurance meet or exceed all national guidelines.
We work closely with other physicians involved in a patient’s treatment to ensure integrated care. We provide regular reports indicating the proposed treatment, progress updates during therapy, and the results achieved after the course of treatment. We are always available to discuss a patient’s care. In addition, the Charles W. Christie Cancer Center has regularly scheduled multidisciplinary tumor board meetings, where our providers and other physicians involved in the a patient’s care meet and review their diagnostic information and make treatment recommendations.
Our doctor reviews all of the patients’ relevant diagnostic information (Pathology reports, CT, MRI, and PET scans) and often confers with other specialists to help determine the extent of the problem and its suitability for specific types of radiation therapy. Our providers discuss treatment along with its benefits and risks with the patient and his or her family. Our physicist, dosimetrist, radiation therapists, and doctor work closely together to develop the most appropriate treatment plan for radiation delivery for each individual.
Making choices for cancer treatment can be overwhelming. At the Charles W. Christie Cancer Center, our providers believe that taking time to educate patients on their disease and their treatment options helps them make the best decisions and reduce their fear and anxiety. All treatment options are presented so that patients can weigh the merits of each. Our team welcomes questions from patients and family members during and after the initial consultation, either by phone or often during additional meetings. Patients are given written educational material designed to teach them about their specific diagnosis and treatment and are often referred to outside reading sources and websites. In addition, patients receive personalized educational sessions with our providers and therapists to let them know what to expect, directions to follow to minimize side effects, and referral for ancillary services for dietary and other support. The educational process continues during weekly visits with our provides once treatment has begun.
The first step in planning, patients undergo a planning CT (and sometimes MRI scan) of the targeted region in the position they will assume for the actual treatments. It is at this time that custom body immobilization devices are created. The planning CT images are sent to a planning computer station, where Dr. Damore utilizes the patient’s diagnostic CT, PET, and MRI scans to define the shape and location of the tumor for targeting. Often, the planning CT images are fused with the diagnostic CT, MRI, and PETCT images on either the Elipse planning system or the MIM system using special software. The doctor and the dosimetrist then use CT images to set up radiation beams that target the tumor and shape the radiation dose to conform to the target.
We use a Linear Accelerator to deliver external beam radiation therapy. The linear accelerator delivers beams of radiation that pass through the body to the cancer, where it destroys cancer cells. The linear accelerator is capable of delivering 3D Conformal Radiation Therapy, which utilizes imaging to define the size, shape, and location of the patient’s cancer in the body and tailor radiation beams using special shielding to target the cancer and protect normal tissue. It also is capable of delivering dynamic Intensity Modulated Radiation Therapy (IMRT). This advanced technology uses a computer to shift small moveable leaves in the path of the radiation beam to vary the intensity of the beam. This tightly conforms the radiation doses around the target and further limits the radiation dose to normal tissue.
Our linear accelerator is a TrueBeam(tm) (Varian corp), which is the most technologically advanced linear accelerator available. Installed in 2018, the TrueBeam(tm) is capable of delivering volumetric intensity modulate arc therapy (VMAT) or Rapidarc ™, an advanced form of IMRT that delivers a precise 3D dose distribution with a 360-degree rotation of the gantry. The TrueBeam system synchronizes imaging, patient positioning, motion management, and treatment delivery.
The linear accelerator is equipped with an Electronic Portal Imaging Device (EPID) that delivers real time digital X-rays of the treatment field to the Radiation Therapists and physician while the patient is on the treatment machine. The team can compare the portal images with the images generated from the treatment plan in real time to verify patient positioning and block shaping to enhance the accuracy of the treatment setup.
The TrueBeam(tm) can also take kv X-rays at intervals during the treatment to verify the location of the tumor during treatment delivery.
The linear accelerator is equipped with an On Board Imaging (OBI) system that can take kV X-rays or low dose CT (CBCT) scans of the targeted area just before the radiation is given each day.
The team then compares images from the initial treatment plan with the images taken just before treatment to see if the patient’s position needs to be adjusted.
In some cases, doctors will implant a tiny marker in or near the tumor to help localize the treatment area. IGRT ensures the patient and the tumor are in the same position as originally planned and improves targeting of the cancer and avoidance of normal tissue.
The TrueBeam(tm) is capable of Respiratory Gating, which turns the treatment beam on and off during phases of the patient’s respiratory cycle. This reduces the amount of normal tissue included in the treatment volume, which reduces the risk of side effects. Respiratory Gating is useful in the treatment of cancers in sites affected by respiratory motion, such as the breast, lungs, liver, and abdomen, particularly with stereotactic treatments.
This is a specialized technique that combines advanced imaging technologies with sophisticated computer guidance to deliver highly targeted radiation beams that conform to the three dimensional shape and size of a tumor. Radiation is delivered at much higher doses compared to daily treatments in short course of therapy (usually one or up to five treatments) to destroy certain types of small tumors. The higher level of precision may allow better sparing of normal tissue, and the higher radiation doses may be more effective. Because this involves a high level of precision, special imaging and body immobilization are used. Initially used to deliver a single treatment in the brain (called SRS), stereotactic treatments are now delivered to the spine, lung, liver, and other sites (called SBRT) in a small number of treatments.
Radiopharmaceuticals are medications that contain radioactive material that are delivered through intravenous injection or oral administration. The body absorbs the radioactive material through its normal metabolic processes and concentrates the radioactivity in specific organs. The most common radiopharmaceuticals are I – 131 (Radioiodine) and RA – 223 (XOFIGO). Radioiodine is used to treat thyroid cancer in some patients, usually after surgical removal of the thyroid gland. Ra-223 is a new, innovative method of treating prostate cancer that has metastasized, based on recent studies that have shown that it can make patients more comfortable and live longer with their disease.