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    Radiation Oncology: DR - Durgesh Mishra Dy - Cmo, MJPJAY, Mah

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    KASATSA
    Dr. Durgesh Mishra discusses various radiation oncology techniques including 3D-CRT, IMRT, SBRT/SRS, HDR brachytherapy, VMAT. These techniques allow for higher and more conformal radiation doses to tumors while reducing doses to surrounding healthy tissues. Key factors to consider for claims include treatment intent, planning images, fraction numbers and doses, areas to be spared, and indications for techniques like IGRT which helps address tumor movement.

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    Radiation Oncology: DR - Durgesh Mishra Dy - Cmo, MJPJAY, Mah

    Uploaded by

    KASATSA
    115 views13 pages
    Dr. Durgesh Mishra discusses various radiation oncology techniques including 3D-CRT, IMRT, SBRT/SRS, HDR brachytherapy, VMAT. These techniques allow for higher and more conformal radiation doses to tumors while reducing doses to surrounding healthy tissues. Key factors to consider for claims include treatment intent, planning images, fraction numbers and doses, areas to be spared, and indications for techniques like IGRT which helps address tumor movement.

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    Radiation Oncology

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    Dr. Durgesh Mishra discusses various radiation oncology techniques including 3D-CRT, IMRT, SBRT/SRS, HDR brachytherapy, VMAT. These techniques allow for higher and more conformal radiation doses to tumors while reducing doses to surrounding healthy tissues. Key factors to consider for claims include treatment intent, planning images, fraction numbers and doses, areas to be spared, and indications for techniques like IGRT which helps address tumor movement.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    115 views13 pages

    Radiation Oncology: DR - Durgesh Mishra Dy - Cmo, MJPJAY, Mah

    Uploaded by

    KASATSA
    Dr. Durgesh Mishra discusses various radiation oncology techniques including 3D-CRT, IMRT, SBRT/SRS, HDR brachytherapy, VMAT. These techniques allow for higher and more conformal radiation doses to tumors while reducing doses to surrounding healthy tissues. Key factors to consider for claims include treatment intent, planning images, fraction numbers and doses, areas to be spared, and indications for techniques like IGRT which helps address tumor movement.

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    © All Rights Reserved
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    Download as pptx, pdf, or txt
    of 13

    Radiation Oncology

    Dr.Durgesh mishra
    Dy.Cmo,MJPJAY,Mah.
    •

    VIDEO
    3D-­CRT

    • The goal of three-dimensional conformal radiotherapy (3D-CRT) is


    to deliver a conformal dose distribution to tumors, while sparing
    surrounding normal structures. 
    • Higher doses of radiation can be delivered to cancer cells while
    significantly reducing the amount of radiation received by
    surrounding healthy tissues.
    • 3D-CRT is used to treat tumors that in the past might have been
    considered too close to vital organs and structures for radiation
    therapy.
    • For example, 3D-CRT allows radiation to be delivered to head and
    neck tumors in a way that minimizes exposure of the spinal cord,
    optic nerve, salivary glands and other important structures.
    IMRT

    • Intensity-modulated radiation therapy (IMRT) uses multiple


    small radiation beams to precisely irradiate a tumor. In addition
    to conform to the tumor volume like 3D conformal
    radiotherapy, the radiation intensity of each IMRT beam is
    divided into small segments and modulated throughout the
    treatment by the multi-leaf collimator (MLC) attached to the
    linear accelerator.
    •  the radiation dose is tuned to focus on tumor and spare
    surrounding healthy tissue as much as possible, therefore the
    possibility of radiation-induce side effects is significantly
    lowered compared with conventional non-modulated 3D
    conformal radiotherapy techniques. 
    SBRT/SRS

    • Stereotactic Body Radiation Therapy (SBRT) is a new treatment regimen that


    uses less (< 5) fractionations and a higher fractional dose to treat certain tumors
    and achieve similar or even better treatment outcome as the conventional
    fractionation scheme.
    • Stereotactic radiation therapy and radiosurgery are ultra-focused radiation to the
    tumor only. The treatment controls the growth of a tumor or abnormal cells by
    either killing the cells directly or by disrupting the ability of the cells to grow.
    • SRS and SRT are very similar, but SRS delivers a large dose of radiation on a single
    day and SRT has a fractionated treatment schedule. This means that in an SRT
    treatment the patient will have treatments spanning multiple days.  Although,
    the total dose in SRT may be larger than in SRS any single day will have a much
    smaller dose delivery.  Both are used for the treatment of localized tumors in the
    brain and more recently in the body sites, called Stereotactic Body Radiation
    Therapy (SBRT) or Stereotactic Ablative Body Radiation (SABR).
    High-Dose Rate (HDR) Remote-Controlled Brachytherapy

    • Brachytherapy is a radiation treatment method by placing


    radioisotopes within or on the tumor. At Stony Brook, we
    have a long experience with brachytherapy, and we use the
    most advanced brachytherapy treatment system.
    HDR Gynecological Treatment
    • Vaginal Cylinder treatments are most commonly performed
    on patients who have had a hysterectomy.  In this scenario
    the applicator has a central metallic tube in which the
    radioactive source will travel.  The cylinder is inserted into
    the vagina and will remain there for the duration of the
    treatment.  
    • HDR Brachytherapy for cervical or endometrial (uterine) cancers
    is typically done using a "tandem and ovoid" (T&O) applicator,
    which reaches both the cervix and uterus. The tandem is a long,
    thin metal tube that is passed through the cervix, into the uterus.
    • The ovoids are circular hollow capsules placed in the vagina,
    pressed against the cervix. Once placed in the vagina, the
    applicator is connected to a machine that automatically feeds a
    radiation source into the applicator, where it remains for a
    predetermined time, known as the dwell time. Once the time is
    up, the machine removes the source and the applicator is
    removed from your vagina. The dwell time can be anywhere from
    15-25 minutes.
    HDR Skin Treatment
    • HDR brachytherapy is an effective treatment option for patients with
    localized non-melanoma skin cancer (NMSC), specifically when the tumor
    cannot be removed surgically because of location or shape, without a poor
    cosmetic result. The use of HDR brachytherapy for the treatment of NMSCs
    is typically limited to superficial tumors (depth ≤5 mm).
    HDR  Prostate Cancer Implant Therapy
    • In the past, prostate permanent implant therapy was widely used.
    However, the patient carries radioactivity within their body for a while. We
    offer HDR temporary implant within the prostate in one or two sessions,
    each one 3-4 hours under sedation or anesthesia. The patients do not have
    any radioactivity and return to normal daily activity immediately after the
    treatment. 
    VMAT

    • volumetric-modulated arc therapy (VMAT) delivers radiation on a linear


    accelerator using a cone beam that continuously rotates around the
    patient. Each rotation is called an arc and one or more arcs might be used.
    • During each rotation, the cone beam is continuously shaped (or modulated)
    by the multi-leaf collimator.
    • In addition, the dose rate (how much radiation delivered for each second)
    and gantry speed (how fast the beam rotates) are also optimized to generate
    highly conformal dose distributions.
    • The radiation is delivered to the intended area only, allowing the radiation
    oncologist to spare more surrounding healthy tissue.
    • Both VAMT and IMRT are equally effective for normal tissue sparing.
    However, the treatment time for VMAT is significantly shorter, thus benefits
    patients who require longer (30 minutes or more) treatment time.
    F&A facts and Std.protocol .
    • Radiation should be approved only for late stage 2 and
    further stages of Carcinomas.
    • Re – Radiation guidelines - Timeline to repeat Radiation
    Treatment for relapse/ recurrence of disease;
    1. Brain – 1 year
    2. Head and neck – 2 years
    3. Thorax and any organ – 2 to 5 years
    • If re radiation asked before above mentioned time
    period , raise query for justifying indication for Treatment.
    3DCRT – For this specific techniques, following areas should be focused on;
    • What is the intent of treatment?
    • CT planning images/ simulation charts mandatory requirement for 3DCRT
    and above packages in CLAIMS

    VMAT /IMRT/IMRT WITH IGRT – Query should be raise for;


    • Number of fraction required
    • Intent of treatment - Radical , Neoadjuvant , Adjuvant only .No IMRT or
    VMAT for Palliative treatment .
    • Dose of fraction •
    • Structure to be saved during RT( This is will justify IMRT and VMAT packages )
    •
    • Indication for IGRT package – IGRT is used to treat tumors in areas of the
    body that move, such as the lungs.• It can be also approved for tumor shrink

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