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R osborn rad-onc-101.2013


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Radiation Oncology 101

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R osborn rad-onc-101.2013

  2. 2. FACTOID: During 2011, an estimated 1.2 million patients were treated with radiation at 2,169 hospital and freestanding sites in the United States. FACTOID: Medicare and Medicaid are the predominant sources of payment for radiation oncology. FACTOID: Nearly two-thirds of all cancer patients will receive radiation therapy during their illness. FACTOID: Three cancers – breast cancer, prostate cancer and lung cancer – make up more than half (56 percent) of all patients receiving radiation therapy. FACTOID: For most cancer types treated with radiation therapy, at least 75 percent of the patients are treated with the intent to cure the cancer, rather than control the growth or relieve symptoms like pain. FACTOID: An average linear accelerator is used for 4,500 to 6,500 treatments per year. FACTOID: The average patient receiving curative external beam radiation therapy receives 29 treatments. FACTOID: LINAC, linear accelerators comprised 88 percent of treatment courses. More specialized radiation treatments such as Gamma Knife and brachytherapy make up the remaining 12 percent. Radiation Oncology The Basics
  3. 3. Treating Cancer in the 21st Century Radiation Oncology is comprised of external and internal radiation based treatments to eradicate, manage and control the growth of cancer. Of the four components deployed to “treat” cancer, Radiation Therapy (RT) – Brachytherapy (Internal) and EBRT will be covered in this presentation
  4. 4. Radiation Oncology is the therapeutic treatment that uses high energy ionizing radiation to treat cancers. Over the last 5 years, advances in image acquisition, storage, and transfer have dramatically impacted how radiation oncology departments work. No longer does treatment hinge on a few images of questionable quality but on a greater variety of high-quality multi-modality images. Having images available throughout the clinical process makes a tremendous difference in how patients are being treated today. Whether in treatment planning or treatment delivery, clinicians rely heavily on images to make decisions regarding radiation therapy treatment protocols. IMAGE NEXUS Radiation Oncology
  5. 5. Key Points of Radiation Oncology      Radiation therapy uses high-energy radiation to kill cancer cells by damaging their DNA. Radiation therapy can damage normal cells as well as cancer cells. Therefore, treatment must be carefully planned to minimize side effects. The radiation used for cancer treatment may come from a machine outside the body “External”, or it may come from radioactive material placed in the body “Internal” near tumor cells or injected into the bloodstream. A patient may receive radiation therapy before, during, or after surgery, depending on the type of cancer being treated. Some patients receive radiation therapy alone, and some receive radiation therapy in combination with chemotherapy.
  6. 6. A radiation oncologist develops a patient‟s treatment plan through a process called treatment planning, which begins with simulation. During simulation, detailed imaging scans show the location of a patient‟s tumor and the normal areas around it. These scans are usually computed tomography (CT) scans, but they can also include magnetic resonance imaging (MRI), positron emission tomography (PET), and ultrasound scans. EVERYTHING BEGINS WITH WORKFLOW Treatment Planning
  7. 7. RadOnc Treatment Planning Treatment plans are typically based on larger numbers of CT images, and other modalities, including MRI, PET, SPECT, and occasionally ultrasound, are employed on a much more frequent basis. Most radiation oncology departments have implemented CT simulation, so they no longer need to borrow time on diagnostic radiology CT scanners. These changes have affected the relationship between radiation oncology and diagnostic radiology. PET/CT images (center) are tools that aid in the simulation (right) in treatment planning (left).
  8. 8. = Days Radiotherapy (RT) Image Patient Plan Patient Treat Patient Image Guided RT (IGRT) Image Patient Plan Patient Image Patient Treat Patient Offline Adaptive RT Image Patient Plan Patient Treat Patient Online Image Adaptive RT Image Patient Plan Patient Image Patient Plan Patient Treat Patient EVERYTHING BEGINS WITH WORKFLOW RadOnc Workflow
  9. 9. RadOnc Market Segmentation
  10. 10. External beam Radiation Treatment “EBRT” Linear Accelerator Used for External-beam Radiation Therapy EBRT Many types of external-beam radiation therapy are delivered using a machine called a linear accelerator (also called a LINAC). A LINAC uses electricity to form a stream of fast-moving subatomic particles. This creates highenergy radiation that may be used to treat cancer.
  11. 11. EBRT – 3D Conformal Radiation Therapy 1 of 6  3D Conformal Radiation Therapy . . . . . . . . . . . . Enables radiation oncologists to utilize medical linear accelerator x-ray machines to direct radiation beams at the cancer.
  12. 12. EBRT – Intensity Modulated RT (IMRT) 2 of 6  Intensity Modulated Radiation Therapy („„IMRT‟‟) Enables radiation oncologists to adjust the intensity of the radiation beam and shape the radiation dose to match the size and shape of the treated tumor with a higher degree of precision than 3D conformal therapy. The net clinical result of this technology is the delivery of higher, more effective radiation doses to tumors while reducing radiation exposure of the surrounding normal, healthy organs.
  13. 13. EBRT – Stereotactic Radiosurgery (SRS & SBRT) 3 of 6  Stereotactic Radiosurgery („„SRS‟‟) Enables delivery of highly precise, high-dose radiation to small tumors. SRS utilizes additional treatment technologies to deliver treatment with greater precision and accuracy than either IMRT or 3D therapy.  SBRT stands for Stereotactic Body Radiation Therapy, a radiation therapy approach which delivers high dose radiation to a target within the body, in either a single treatment session or up to approximately five treatment sessions (each session is typically referred to as a “fraction”).
  14. 14. EBRT – Image Guided RT (IGRT) 4 of 6  Image Guided Radiation Therapy („„IGRT‟‟) . . . . Enables radiation oncologists to utilize x-ray imaging at the time of treatment to identify the exact position of the tumor within the patient‟s body and adjust the radiation beam to that position for better accuracy.
  15. 15. EBRT - Volumetric Modulated Arc Therapy (VMAT)5 of 6  Volumetric modulated arc therapy (VMAT) is a more advanced method than IMRT. VMAT enables the physician – in real time – to govern the formation of the beam, the speed of the linear accelerator‟s rotation around the patient and the dosage given to the patient, thus enabling faster and more precise treatment.
  16. 16. EBRT – Proton Therapy 6 of 6  Proton therapy is another form of external radiation treatment. During the treatment, a particle accelerator is used to aim the proton beams at the tumor. Proton therapy used to a limited extent due to the major investment costs required for the unit.
  17. 17. Internal Radiation Therapy “IRT”  High-Dose Rate Remote Brachytherapy . . . . . . . . Enables radiation oncologists to treat cancer by internally delivering high doses of radiation directly to the cancer site using temporarily implanted radioactive elements for eradication of cancer.  Low-Dose Rate Brachytherapy . . . . . . . . . . . . . . Enables radiation oncologists to treat cancer by internally delivering doses of radiation directly to the cancer over an extended period of time using permanently implanted radioactive elements (e.g., prostate seed implants).
  18. 18. Systemic Radiation Therapy  Systemic radiation uses radioactive drugs called radiopharmaceuticals (RP). These unsealed radiation sources are usually in the form of a liquid. Examples are strontium 89 and iodine 131. The radiopharmaceuticals may be given in a vein (IV) or taken by mouth. They travel throughout the body and collect where the cancer is. This is where they give off their radiation to kill the cancer cells.  The radiopharmaceuticals are kept in special containers that hold the radiation inside so it cannot affect others. Treatments are performed in a shielded environment due to ionizing radiation. Technologist adhere to safety protocols for radioactive drugs.
  19. 19. Radiation Oncology is a $3.1 Billion to $4.2 Billion US Market Place RadOnc Market
  20. 20. US Market