Our physicians thoroughly review all of patient records and any prior radiology studies (CT, MRI, PET, x-ray) prior to the patient visit. Often the case has been discussed with a team of physicians including your surgeon and medical oncologist at Tumor Board.
A resident physician will take a careful history and perform a physical examination and review these findings with an attending physician. Both physicians will see the patient together and make specific recommendations for treatment.
The physicians are available to answer any questions regarding the patient’s condition and treatment. If radiation would be beneficial for the patient, the physician will recommend one of the following treatments:
Stereotactic Radiosurgery for brain and intracranial tumors
Prostate Seed Implantation
External Beam Radiation Therapy
Often the treatment recommendation includes external beam radiation as part of treatment. The next step is treatment simulation.
- Simulation: Radiation therapy must be individualized to the patient’s needs. We ask the patient to return for a treatment planning session called simulation. During this session, the physician, in conjunction with a radiation therapist, will perform at CT scan or multiple x-rays to map out the location of the tumor and surrounding normal tissues. Occasionally, IV contrast or oral contrast will be given to allow the physician to more accurately interpret the CT. The therapist may place temporary markers to outline the tumor and often will create a foam cradle or other device to ensure that the tumor is in the same place for every treatment. The simulation usually takes from 30 to 60 minutes.
- Treatment Planning: With these images, the physician works with the physicist and dosimetrist to determine how best to treat the tumor, while avoiding nearby normal tissues as much as possible. This is a very involved process in modern radiation therapy. The physician will review the physical examination, all radiology images (CT, MRI, PET/CT, x-ray) and operative reports to determine the extent of the tumor. The physician must also consider sites of possible spread that are not visible with even the most advanced imaging technology. The physician will outline the target area as well as the important normal tissues. In all cases, the physician and physicist will determine the best strategy to control the tumor with the least risk of complications. For certain cases, IMRT or 3D-conformal therapy will be the best approach to treating the tumor. In other cases, conventional radiation is the best treatment.
- Radiation Therapy: After the physician reviews the treatment plan and prescribes a course of radiation, the patient returns for daily treatment, which generally occurs Monday through Friday for two to eight weeks. High energy x-rays or electrons are produced by a machine called a linear accelerator. The treatments are delivered by a specially trained and licensed radiation therapist. The treatments take only a few minutes to deliver and are painless. However, it takes time to carefully set up the patient accurately every day, so the patient should expect to spend roughly 15 to 45 minutes in our department for each visit. At least once per week, our physicians will examine the patient to assess how the treatment is progressing. The physician, nurse, radiation therapist and other professionals involved in the patient’s care are always available for any needs that the patient may have. A physician is on call 24 hours a day for any emergencies that occur during treatment.
Novalis - The Perfection of Radiosurgery
Novalis, BrainLAB's dedicated system for non-invasive stereotactic radiosurgery and radiotherapy (SRS/SRT), represents cutting-edge technology for highly precise treatments of brain as well as head & neck tumors, arteriovenous malformations and certain functional disorders. Novalis Body features image-guided radiosurgery for high precision treatment of body targets. Its X-ray-based localization technology allows physicians to localize tumors with sub-millimeter accuracy and to position patients automatically and with a higher degree of precision than previously possible. With Novalis Body dose escalation protocols and SRT treatments for spine, lung, liver and other body lesions can be carried out quickly and efficiently.
Mount Sinai is the only site in New York City and only one of four in New York state using Novalis shaped beam radiosurgery.