Karmanos - Crittenton Cancer Center IMRT New Breast Cancer Technology- IMRT Advanced radiation technologies at Crittenton hospital are giving hope to the more than 200,000 women in the United States diagnosed with breast cancer each year. Recent studies show that cutting edge treatment may prove more effective and produce fewer side effects than traditional radiation therapy. Each new patient’s prognosis and treatment plan is review by our multidisciplinary teams in a stimulating academic like atmosphere during clinical conferences. In effect patients benefit from multiple “second opinions” by having many medical minds focused on their case. Referring health professionals are invited to attend these clinical conferences to create an open dialogue between primary care physicians, specialists and the oncologists. Crittenton Hospital Medical center offers many services for the detection and treatment of breast cancer such as mammography, stereotactic biopsy, ultrasound guided biopsy and bone scintigraphy. “The radiation oncology centers at Crittenton Hospital are dedicated to providing the most aggressive and medically sound treatment regimens in pursuit of eliminating cancer or sustaining quality of life” Intensity Modulated Radiation therapy (IMRT) – General Information IMRT is a new form of radiation therapy that uses computer generated images to plan and then deliver more tightly focused radiation beams to cancerous tumors than is possible with conventional radiotherapy. With this capability clinicians can deliver a precise radiation dose that conforms to the shape of the tumor while significantly reducing the amount of radiation to surrounding healthy tissue. Consequently the technique can increase the rate of tumor control while significantly reducing adverse side effects. Both breast cancer patients and prostate cancer patients are benefiting from this advanced radiation therapy. IMRT also is used to treat cancer of the head and neck, cervix, colon, rectum and brain. The radiation consists of thousands of tiny beamlets each focusing on a different area of the tumor. These beams can turn corners or make concave shapes. This degree of precision and control is not possible with other conventional radiation techniques. A powerful computer program optimizes a treatment plan designed by the physician will generate information about tumor size shape and location in the body. A medical linear accelerator equipped with a special device called a multileaf collimator (MLC) that shapes the radiation bean delivers the radiation according to the treatment plan. The equipment can be rotated around the patient to send radiation beams from the most favorable angles to give the tumor a higher dose while preserving normal healthy tissue. “Because the IMRT is so precise, we are able to deliver three times the normal radiation dose to the tumor" says Dr. Arterbery Frequently asked questions about IMRT (FAQ) Will I be radioactive with IMRT? External radiation does not cause a patients body to become radioactive. Patients need not avoid being with other people because of treatment. Even hugging, kissing or having sexual relations with others poses no risk of radiation exposure. Many people when they hear the word radiation, think immediately of radioactive substances. However, no radioactive substances are involved in the creation of the radiation beams for treatment. When the accelerator is switched ``on,`` radiation is produced and aimed directly at cancer cells. Then like a flashlight when the machine is switched “off,“ there is no more radiation. It is not stored or transported. Why is IMRT better? IMRT is the most precise form of radiation therapy available, allowing an escalation of the radiation dose to cancer cells, and in some cases, even more precisely to specific regions within a tumor. What is the treatment program like? The first IMRT treatment is sometimes longer than subsequent ones, so that additional x-ray films and quality assurance checks can be done. A typical treatment session lasts about 15 minutes. Radiation is usually given five days a week for six or seven weeks. For palliative care the course of treatment may last for two or three weeks. These types of schedules which use small amounts of daily radiation rather than a few large doses help protect normal body tissues in the treatment area. Weekend rest breaks allow normal cells to recover. The total dose of radiation and the number of treatments depends on the size and location of the cancer, the type of tumor, the patient’s general health, and other factors. What is the IMRT process like? The IMRT process is dependent on each physicians approach. Typically, after a physical exam and review of x-rays and medical records, the radiation oncologist determines an individualized course of treatment for each patient. How is the treatment prepared? There are three basic steps to delivering IMRT Diagnosis x-rays, pathology report, physical exam, PET scan, CT and or MRI Treatment planning physicians specify the exact dose of radiation Delivery of treatment Most cases require a treatment preparation session called a simulation. Special molded devices that help the patient maintain the same position every day are developed. Small tattoos are used to mark the patients skin to assist in aligning the radiation equipment with the target area. X-rays may be taken in preparation for treatment planning. Following the simulation, a targeted CT scan is performed in the treatment position so that the doctor can define the tumor area. MRI and PET scan images also are used to define the tumor when applicable. Simulation and CT scanning typically take 1-1.5 hours. IMRT planning usually takes several days. When the plan is complete the patient is given an appointment to begin radiation treatments. Treatment sessions last typically 15- 20 minutes. How does radiation therapy work? Cancer cells grow and divide more rapidly than many normal cells. High doses of radiation can kill cells or keep them from growing and dividing. Radiation has proven to be effective in killing cancer cells and shrinking tumors. Although some normal cells are affected by radiation, most normal cells recover much more fully from the effect of radiation than do cancer cells. Who gives the radiation treatment? A radiation oncologist who has special training in using radiation to treat disease prescribes the type and amount of treatment that best suits a particular patient’s need. The radiation oncologist works closely with other doctors and also directs a trained health care team. This team often includes the 1) Radiation Physicist who participates in the planning process and ensures that the machines deliver the right dose of radiation; 2) Dosimetrist who plans the treatment with the oncologist and the physicist; 3) Radiation Therapist who sets the patient up for treatment and runs the equipment that delivers the radiation.