Radiation Therapy at Paris

Imaging Equipment

• >Computed Tomography (CT)
  Computed tomography (CT) is a quick and painless procedure that combines X-rays with computers to produce highly detailed cross-sectional pictures of your body. The images provide valuable information for staging your cancer or planning your treatments. Learn More.
  • >CT simulation

    After the initial consultation and decision to use radiation treatment, the next session is usually a planning session, which is called a simulation. Simulation is used to determine the radiation treatment fields and most of the treatment planning. Of all the visits to the radiation oncology facility, the simulation session may actually take the most time.

    The CT simulator does not deliver radiation treatment, but instead allows the radiation oncologist and technologists to see the area to be treated. Images are obtained and transferred to the planning system where a virtual 3D image of the patient is created, and the treatment delivery plan is developed.

    For the simulation session, temporary marks are made on your skin with markers to identify the treatment areas. The room is periodically darkened while the treatment fields are being set. Alignment is critical during simulation and is facilitated by lasers mounted on the wall and ceiling. Special individually constructed immobilization devices may be used to help achieve this alignment. While you may see red lines of light, the low energy lasers are for alignment purposes only and you will not feel burning or anything else from the laser light.

    Once the aspects of the treatment fields are set, the technologist will take special simulation X-rays representing the treatment fields. In most centers, the patient is given multiple “tattoos,” which mark the treatment fields and replace the marks previously made with magic markers. These tattoos are not elaborate and consist of no more than pinpricks followed by ink, appearing like a small freckle. Tattoos enable the radiation technologists to set up the treatment fields each day with precision, while allowing you to wash and bathe without worrying about obscuring the marks that indicate where treatment will be delivered.

    Sometimes several simulation sessions are necessary in order to optimize treatment and are often performed prior to planned “boost” or “reduced field” treatments as part of the overall treatment plan. Learn More.
  • >Diagnostic CT imaging
    A CT scan can help doctors diagnose cancer and identify a tumor’s shape, size, and location. Learn More.
• >Diagnostic X-ray
  X-ray imaging can be used to detect cancer and other abnormalities in different parts of the body. Images produced by X-rays show shadow-like images of bones and certain organs and tissues, useful in cancer diagnosis. For example, chest radiographs and mammograms are often used for early cancer detection or to see if cancer has spread to the lungs or other areas in the chest. Learn More.
• >Positron Emission Tomography (PETCT)
  PET/CT is a powerful imaging tool that combines a PET (positron emission tomography) scan and a computed tomography (CT) scan. PET/CT is used to diagnose, stage, or restage your cancer, as well as evaluate the effectiveness of treatment. The images provide information about the location, nature, and size of your tumor. PET/CT is available at many locations, including Texas Center for Proton Therapy, whose PET/CT technology enables some of the fastest imaging available with the best image quality. The CT’s newer technology and faster scan times may result in less radiation exposure to patients. Its wider open design decreases claustrophobia and provides better access for larger patients and radiation therapy planning for cases requiring more space, such as breast cancer. Learn More.
  • >Diagnostic PETCT imaging
    For some types of cancer, a PET/CT scan is a useful way to help find cancer and learn its stage. PET/CT imaging provides your doctor with a detailed 3D result showing abnormalities. These images provide information about how the cancer is affecting your body's functions and helps your doctor choose the best treatment. Learn More.

CT Simulation Techniques

• >3D simulations
  Three-dimensional conformal radiation therapy (3D-CRT) is delivered by radiation beams positioned from different directions that are designed to match the shape of the tumor. This helps to reduce radiation damage to normal tissues and better kill the cancer by focusing the radiation dose on the tumor's exact shape and size. Learn More.
• >4D CT scanning
  Four-dimensional computed tomography is a type of CT scanning which records multiple images over time. Images are mapped to the breathing cycle to give care teams more information about respiration and internal movement for treatment planning. Planning 4D-CT scans can be used to minimize target volumes for lung cancer radiotherapy. Learn More.
• >Virtual Simulations
  Simulation is the first step in the radiation oncology treatment process and involves consultation with your physician and radiation therapy team to plan for treatment. Planning includes determining the correct body position for treatment, taking imaging scans, making reference marks for the positions on the skin, and virtual simulation. During virtual simulation, the images taken earlier in treatment planning are used to create a 3D model of your anatomy, including the tumor and its location, which augments an oncologist’s ability to plan the optimal course of treatment. Learn More.

External Radiation Therapy

• >Conventional 2D, 3D, electron treatments
  • Conventional 2D – Conventional (2D) radiation therapy refers to the technique of radiation therapy where treatments are planned by defining a limited number of beams with the boundaries delineated on patient X-rays. Conventional 2D radiation therapy is typically used for palliative treatment.
  • 3D Conformal Radiation – A type of external beam radiation therapy, 3D conformal radiation therapy combines images from CT, MRI, and PET scans to plan the radiation treatment. Software analyzes the images and helps direct radiation beams to conform to the tumor’s shape.
  • Electron Treatments – Electron therapy uses electrons directed to the outer layers of the skin to cover the surface of the body. It does not go into deeper tissues or organs.  

  Learn More.
• >Intensity modulated radiation therapy (IMRT)
  Intensity modulated radiation therapy (IMRT) is an advanced form of non-invasive radiation treatment enabling radiation oncologists to precisely target tumor cells. It uses computed tomography (CT) to create 3D images and treatment plans to deliver targeted radiation beams of varying intensity to cancerous tumors. By using image-guidance technologies, your radiation oncologist can localize your treatment and minimize damage to surrounding tissue. Learn More.
• >Stereotactic Body Radiotherapy (SBRT)
  Stereotactic radiosurgery (SRS) and stereotactic body radiotherapy (SBRT) are non-surgical procedures that deliver precisely-targeted radiation at very high doses with minimal damage to surrounding healthy tissue. SRS uses a computer-guided therapy system to treat tumors and other abnormalities of the brain. SRS is ideal for otherwise inoperable tumors, such as those that cannot be treated by traditional surgical methods. SBRT is used in areas of the body other than the brain to treat malignant or benign small to medium size tumors. Learn More.
• >Stereotactic Radiosurgery (SRS)
  Stereotactic radiosurgery (SRS) and stereotactic body radiotherapy (SBRT) are non-surgical procedures that deliver precisely-targeted radiation at very high doses with minimal damage to surrounding healthy tissue. SRS uses a computer-guided therapy system to treat tumors and other abnormalities of the brain. SRS is ideal for otherwise inoperable tumors, such as those that cannot be treated by traditional surgical methods. SBRT is used in areas of the body other than the brain to treat malignant or benign small to medium size tumors. Learn More.
• >Stereotactic Radiotherapy (SRT)
  Like stereotactic radiosurgery (SRS), stereotactic radiotherapy (SRT) uses a computer-guided therapy system to deliver large doses of radiation. However, instead of a single session, radiation is delivered on multiple days divided into several doses. Learn More.
• >Volumetric Modulated Arc Therapy (VMAT): Rapid ARC

  Volumetric modulated arc therapy (VMAT) is a type of radiation therapy used to deliver highly-specific treatment doses, while minimizing damage to normal tissues. A linear accelerator moves around the patient 360 degrees to deliver the radiation to the tumor.

  • RapidArcTM – Varian RapidArcTM is an advanced form of intensity-modulated radiation therapy (IMRT) that allows radiation oncologists to send multiple doses of precise beams in the 3D shape of tumors. RapidArcTM uses computed tomography (CT) or other imaging technology to pinpoint tumors and guide the radiation beam around the patient.

  Learn More.

Image-Guided Radiation Therapy

• >Electronic Portal Imaging Device (EPID)
  Electronic portal imaging devices (EPIDs) measure X-ray intensity transmitted through a patient during treatment. This measurement is transformed into a 2D digital image to accurately align the radiation beam to the tumor. Learn More.
• >Onboard Imaging - Conebeam CT, Kilovotage imaging, Fluoroscopy
  Onboard imaging allows care teams to better align treatment to a tumor that may have a complex shape or move, which damage to healthy tissues.

  • Cone Beam Computed Tomography (CBCT) – Physicians use Cone Beam Computed Tomography (CBCT), which utilizes 3D volumetric imaging (vs. 2D X-ray images), to provide improved visualization, better patient positioning, and more precise treatment of cancerous tumors.
  • Kilovoltage Cone Beam Computed Tomography (kV-CBCT) – A type of board imaging, kilovoltage Cone Beam CT allows care teams to make adjustments to the X-rays that impact the intensity and quality of the image.
  • Fluoroscopy – Fluoroscopy is another medical imaging test that can be used in IGRT. An image of the area is created by sending an X-ray beam continuously through the body to create an image. Physicians can view the image on a monitor in real time to see the movement of internal organs.

  Learn More.

Respiratory Gating

• > Varian RGSC or RPM
  Varian respiratory gating for scanners (RGSC) or real-time position management (RPM) gives care teams the ability to accurately allow for tumor motion and patient breathing in treatment planning.

Brachytherapy Procedures

• >High Dose Rate (HDR) Brachytherapy
  High dose rate (HDR) brachytherapy uses radioactive material inserted into applicators placed within body cavities or tissues to deliver a high dose of radiation precisely to the tumor. Learn More.
  • >Breast Cancer HDR- Mammosite, SAVI, Contoura

    High Dose Rate (HDR) internal radiation therapy utilizes radioactive material inserted into applicators within body cavities or tissues in close proximity to the tumor, allowing for a high dose of radiation to be delivered precisely to the tumor. HDR brachytherapy is a temporary implant conducted in an outpatient setting and minimizes treatment time. Imaging tools such as CT (computed tomography) verify the exact catheter or applicator placement, resulting in a radiation dose with one-millimeter accuracy that significantly spares radiation exposure to surrounding healthy tissue and critical organs. For breast cancer, several options are available. Your physician will discuss which the most appropriate option for you.

    • The SAVI™ applicator delivers a high daily dose of HDR brachytherapy via multiple catheters that allow clinicians to contour the radiation and protect nearby healthy tissue. This approach provides greater flexibility in the delivery of radiation.
    • The Contura™ balloon delivers a high daily dose of HDR brachytherapy via five channels for the radioactive source. These channels allow clinicians to shape the radiation and administer radiation only where it is needed, thus protecting healthy tissue. Treatment time is decreased to just five days versus up to seven weeks.
    • MammoSite^® delivers a high daily dose of HDR brachytherapy to the area where breast cancer is most likely to recur after a lumpectomy. The radiation can kill any remaining cancer cells. MammoSite^® works from inside the body via a discreet balloon catheter system implanted in the breast lumpectomy 

    Learn More.
  • >Gynecological HDR
    HDR internal radiation therapy is used to treat gynecologic cancers by delivering radiation internally and precisely targeting the tumor. This precision minimizes the impact on the surrounding healthy tissue and limits side effects. The radiation is delivered through an applicator that is inserted internally and is removed once treatment is complete. Treatment time is significantly reduced to three to six treatments that last 10 to 20 minutes each.  Learn More.
  • >Prostate Cancer HDR
    Prostate HDR brachytherapy involves temporarily implanting flexible needles within the prostate to allow the delivery of treatment using radioactive materials. Treatment time is reduced to one and a half days and it is an alternative treatment option for qualifying patients as compared to external beam treatments, which last five to seven weeks. Learn More.
  • >Skin HDR
    Skin HDR internal radiation therapy is a convenient, effective treatment alternative with outstanding results and minimal side effects. A radioactive seed travels through an applicator and delivers a precise radiation dose directly to the target within one-millimeter accuracy. It achieves good to excellent cosmetic results and is a good treatment option for cancers around the eye and nose that are more difficult to treat surgically. It is typically administered two to three times per week for a total of six to 10 treatments. Treatment takes less than 10 minutes and is painless.  Learn More.
• >Prostate Seed Brachytherapy
  A type of brachytherapy radiation treatment, prostate seed implants are very small radioactive pellets permanently inserted into the prostate. They give off low doses of radiation over time and become inert. Learn More.

Radiation Information Systems

• > Elekta Mosiq
  Elekta MOSAIQ® Care Management software helps manage all aspects of a radiation oncology program, keeping patient information easily accessible while simplifying complex treatment management, personalizing decision support, and reducing errors and wait times.