Department of Radiation Oncology Welcome to Radiation Oncology at Emory Clinic Every member of Emory Clinic Department of Radiation Oncology strives to provide the highest quality of care for you as our patient. Our goal is to design a treatment experience that is tailored to your specific needs in a caring and supportive environment. Walter J. Curran, Jr., MD Lawrence W. Davis Chair and Professor, Department of Radiation Oncology Executive Director, Winship Cancer Institute of Emory University This brochure introduces you to each member of our treatment team. We hope it will provide you with useful information about your treatment experience. A cancer diagnosis can cause stress and discomfort for you and your loved ones. We want to make you as comfortable as possible during your therapy. If you have questions after reading this material, do not hesitate to ask any member of our Radiation Oncology team. We are always eager to help improve your experience in any way we can. National Cancer Institute Doctors are drawn to Emory because of the tremendous attention given to patient care and research. Many new cancer treatments are not only tested at Emory but are actually developed here. Our patients benefit from all of this knowledge. Dr. Walter J. Curran, Jr. The Winship Cancer Institute of Emory University has earned the prestigious National Cancer Institute (NCI) Cancer Center Designation. This means that Winship is now counted among the nation s elite cancer research and treatment centers. The NCI Cancer Center Designation is earned only by those facilities that provide the most advanced treatment options, backed by groundbreaking research and offered in a caring and efficient environment.
People You Will Meet A patient services representative at the reception desk will greet you and register you to see the doctor. He or she will also help you schedule any necessary follow-up visits. Medical assistants will prepare you to see the physician. They will accompany you into the exam room, record your vital signs and assist with medical procedures. Our nurses are actively involved in your care and are readily available to help you. Before beginning treatment, a registered nurse will teach you about radiation treatment and share information to help manage any side effects you might experience. In addition to your physician, you may meet a resident physician who is undergoing specialized training in radiation oncology. He or she works under the supervision of the attending radiation oncologist. Nurse practitioners will collaborate with you and the physician in your ongoing medical care. They are available to assist with questions about your treatment and help manage any side effects that may occur. You will meet with a radiation oncologist to discuss your care and treatment options. Our physicians are board-certified experts in using radiation to treat tumors. Your radiation oncologist is the leader of your treatment team. Radiation therapists will administer your treatment. They will deliver the radiation precisely as the doctor has prescribed using a machine called a linear accelerator. You and your therapist will schedule a time for your daily treatments. Emory Radiation Oncology has been awarded a three-year term of accreditation in radiation oncology s the result of recent review by the American College of Radiology (ACR). Accreditation is awarded only to facilities meeting specific Practice Guidelines and Technical Standards developed by ACR after peer-review evaluation by board certified radiation oncologists and medical physicists who are experts in the field.
Other Members of the Team Dosimetrists are responsible for working with physicians to plan the best way to deliver radiation to the tumor. The goal is to minimize radiation to nearby healthy tissue. Using a special computer, the dosimetrist calculates the direction of the radiation beam and the type of equipment to be used. Physicists validate treatment plans and conduct quality tests on the treatment machines. These frequent tests ensure the equipment is operating safely, accurately and consistently. A social worker is available to meet with you and your loved ones during treatment. He or she can assist you with concerns you may have about transportation or temporary housing during treatment. He or she may also help address personal or family issues related to your diagnosis or treatment. A dietician can help you manage side effects such as weight loss or nausea that you may experience over the course of radiation therapy. A lymphedema therapist is available for patients who experience swelling of the lymph nodes. Your physician will recommend a consultation with this specialist if he or she feels you would benefit from it. A financial counselor and members of our billing staff are available to help you understand the financial aspects of radiation treatment. Parking Our department will pay for your parking while you are receiving treatment. You may use either the valet services (at the front entrance of the Winship Cancer Institute of Emory University) or the patient and visitor parking deck. Each day that you visit us for treatment, ask your therapist to validate your parking ticket. Please note that parking cannot be validated for consultations, follow-up visits or visits with other departments.
Consultation Consulting with the radiation oncologist is the first step of treatment. During your consultation, the doctor will perform a physical examination and review your medical history and radiology scans. He or she will explain the need for treatment and review different treatment options. Together, you will discuss the goals and side effects of treatment. Radiation may be used as a stand-alone treatment, and often it is the only treatment needed. Radiation is also used in combination with surgery, chemotherapy and biological therapy. For example, doctors can use radiation before surgery to shrink a tumor, or after surgery to stop the growth of remaining cancer cells. Simulation The next step of radiation therapy is to develop a treatment plan. To start this process, the doctor will conduct a computed tomography (CT) scan (detailed X-ray imaging). You will be placed in a CT scanner like the one shown in the picture above. The therapist will create a device to hold your body in the proper position for scanning, which often depends on the location of your tumor. Customized pads or a head mask may be used. The CT scan will be used to design your treatment plan. After the scan, you will have a cast (Vac-Loc ) made or ink marks placed on your skin. These non-permanent marks will be used to position you for each treatment, so it is very important that they remain on your body during the full course of radiation therapy. The simulation process can last anywhere from 10 to 60 minutes. Over the following week, your treatment team will use data from the CT images to plan your treatment. Approximately one week after your CT simulation, your treatments will begin.
Clinical Trials Emory s Department of Radiation Oncology actively participates in many clinical trials. These trials study potentially more effective treatments for cancer and methods of preventing side effects. We are a member of the Radiation Therapy Oncology Group (RTOG), a national clinical trials cooperative group specializing in radiation therapy. Our department also supports the research efforts of these cooperative groups: the Children s Oncology Group (COG), the Eastern Cooperative Oncology Group (ECOG) and the Adult Brain Tumor Consortium (ABTC). In addition, the department is actively involved in pharmaceutical-industry and independent clinical trials. All of these clinical trials are designed to investigate new or additional treatment options that research suggests may be better than the current standard treatments. The department s participation in clinical trials provides our patients with leading-edge treatment options and the best possible care. Ask your radiation oncologist if you are eligible to participate in a clinical trial. Radiation Therapy Techniques Three-dimensional (3-D) conformal radiotherapy involves carefully calculated, externally delivered X-ray beams to treat tumors. RapidArc is a volumetric arc therapy (VMAT) that delivers a precisely sculpted 3D dose distribution with a single 360-degree rotation of the linear accelerator gantry. Intensity-modulated radiotherapy (IMRT) involves external radiation beams that are designed to be more tightly focused on the tumor shape, minimizing damage to surrounding healthy tissue. Brachytherapy, or internal radiation therapy, is different from IMRT or 3-D conformal radiotherapy. Brachytherapy uses radioactive materials placed very close to tumors to kill cancer cells, while minimizing radiation exposure to nearby healthy tissue. Stereotactic radiosurgery (SRS) is an outpatient procedure used to treat brain tumors. Despite its name, it is not surgery; it is performed in the Radiation Oncology Department using a linear accelerator. Because SRS delivers a very high radiation dose to the tumor, sophisticated measures are taken to ensure accurate delivery of the radiation. Stereotactic body radiosurgery (SBRS) is a type of radiation therapy that uses a very high dose of radiation delivered to a precise area of the body. The procedure uses special positioning and radiology techniques to spare normal tissue so that a higher dose of radiation can be used. It is also used for a shorter period of time than traditional radiation therapy. What to Expect: Your therapist and oncologist may ask for your name and date of birth often. Please do not be annoyed or offended by this. We use this information to ensure that every patient seen in our Clinic is properly identified before receiving treatment. We take your picture when you start treatment for the same reason. Emory offers the most advanced cancer treatment technologies, including: RapidArc Radiotherapy Technology Vision RT s AlignRT Imaging Technology Novalis Radiosurgery Technology
Treatment On your first day of treatment, will be acquainted with your radiation therapist and your treatment room. The Radiation Oncology Department has several linear accelerators, including the Varian TrueBeam TM. These machines use the most advanced technology to deliver your radiation treatment. You will be assigned to the same room for all of your treatments. Your radiation therapist will use images like X-rays and On-Board Imager scans (OBI see box below) to ensure that you are positioned properly for your treatment. Your radiation oncologist will view these images and confirm your treatment plan. Once you are positioned, your treatment can begin. It is very important that you do not move after you have been correctly positioned. If you are uncomfortable or if you are having trouble holding yourself still, let your therapist know. He or she can help you reposition. The therapists leave the room during treatment and observe you using a closed-circuit television. The treatment machine will make a steady buzzing noise when the beam is on, and the machine may rotate around you. You will not feel anything during treatment. If you feel sick or uncomfortable during the treatment, notify the therapist immediately. Treatment Schedule OBI: On-Board Imager An OBI (On-Board Imager) system is attached to the linear accelerator hence its name. This special, low-energy X-ray machine enables better bony anatomy visualization than traditional port films. OBI images are used to precisely position your body for therapy. Shifts in your body position are caused by movement, daily set-up and even simply breathing. During treatment, OBI images may be taken at each appointment. By comparing OBI images to the pre-treatment CT scan, your doctors can make necessary adjustments to ensure your treatment stays on target. Radiation treatments are usually performed Monday through Friday (not on weekends). Unless your doctor tells you otherwise, continue your regular prescription medication schedules. Treatment usually lasts anywhere from two to eight weeks. Unless you request to miss a day of radiation or are otherwise notified, you will receive treatment at the same time every day. You will be in the Radiation Department approximately 30 minutes each treatment day. During treatment, it is possible that your treatment plan may be revised depending on your progress and your response to the therapy. This is not uncommon. What must stay consistent is your attendance: do your best not to miss a treatment because unnecessary delays can reduce the effectiveness of therapy.
Managing Your Care Throughout Treatment X-ray images are taken throughout your treatment. These films confirm position and location of therapy and do NOT assess your tumor s response to treatment. Once a week, your radiation oncologist will meet with you to assess how you are doing, order necessary lab work or other tests, and answer any questions you may have. If at any other time during the week you have questions or concerns about side effects or symptom management, our nursing staff is more than happy to assist you. Follow-Up Care Your physician will plan your follow-up care. It is important to have regular follow-up exams to monitor the results of your treatment. In addition to follow-up appointments with your doctor, you may also need to undergo occasional CT or magnetic resonance imaging (MRI) scans. Follow-up care is personalized to your individual needs and treatment. Taking care of yourself and maintaining healthy habits following your treatment are part of your follow-up care. Important Phone Numbers Radiation Oncology Emory Clinic 404-778-3473 Radiation Oncology Emory University Hospital Midtown 404-686-2391 On-Call Radiation Oncologist 404-778-5000 Find us on the Web! What you will find on our Web site: News and announcements Treatment and clinical trial information Physician biographies Our mission statement and history And much more!