Radiation Oncology

About Radiation Oncology

The Cancer Center’s Radiology Oncology Department provides all of the most advanced radiation therapy treatment methods that are available today.

Radiation therapy is the use of high-energy, penetrating radiation, which is utilized to shrink tumors and kill cancer cells. It is delivered using a machine called a linear accelerator.

Radiation therapy can be given in either two forms: externally or internally. During external therapy, the linear accelerator directs the high-energy X-rays or particles at the cancer and the normal tissue surrounding it. During internal radiotherapy, also known as brachytherapy, implantable devices are inserted inside the body to deliver a concentrated dose of radiation directly to the tumor or body cavity.

The Radiation Oncology Department offers a dedicated team of on-site radiation oncologists who provide disease-specific expertise. They are on the cutting edge in the development and use of organ preservation therapies. They are charged with prescribing the appropriate treatment and type of machine based on the type of radiation and energy required to treat the area. Radiation treatments are delivered by a licensed and certified radiation therapist.

The different types of radiation therapy available at The Cancer Center include:

  • TomoTherapy for prostate cancer and head and neck cancers;
  • Intensity modulated radiation therapy for a variety of cancers;
  • Brachytherapy, both seed implants and high-dose-rate treatments for a variety of cancers, including prostate, gynecologic, and head and neck cancers;
  • 3-D conformal radiation therapy for a variety of cancers, including many types of head and neck cancers;
  • Partial breast irradiation using MammoSite targeted radiation therapy, which reduces treatment from six weeks to five days for many patients
  • External beam radiation therapy for a variety of cancers; and;
  • Non-invasive, same-day XKnife stereotactic radiosurgery at the medical center’s Institute for Radiosurgery, which is used to treat malignant and benign tumors of the brain and other parts of the head.

The radiation oncology’s team includes board-certified radiation oncologists, physicists, technologists, nurses, and support staff. The department also has licensed social workers and registered dietitians to aid patients who are undergoing radiation therapy with psychosocial issues, referrals to community services, and nutrition counseling to help patients cope with changes in diet, appetite, and side effects that may occur during radiation therapy.

Research

The Radiation Oncology Department participates in clinical trails with the national Radiation Oncology Group of the National Cancer Institute and independent agencies and pharmaceutical companies in evaluating new types of radiation therapy treatments, new methods of treatment, and new regimens and protocols for the delivery of radiation therapy, including combining radiation therapy with chemotherapy, surgery, radiofrequency ablation, and cryosurgery.

Planning For Your Treatment

The first appointment needed after the consultation is called a “simulation.” This is a “mapping out” session where a radiation therapist positions you in the necessary treatment position and takes a series of X-rays or special CT scans to outline the treatment area that has been prescribed by your physician. If you have any special needs when lying on the table please tell your therapist before lying down. The simulation takes approximately one to two hours. Please note that these CT scans provide a guide for treatment planning purposes only. They are not scans to evaluate the status of disease nor are they tests to measure how your tumor is responding to the treatment. The data from the scan is collected, and a computerized treatment plan specific to your body is generated by the department’s physicist and medical dosimetrist.

In order for you to remain still during the treatments, a customized positioning tool called an immobilization device may be created for you. Immobilization devices can consist of face masks or arm, leg, body, or pelvic molds. In addition to keeping you still on the treatment table, these devices are utilized to help the radiation therapist place you in the same position on a daily basis.

Throughout the simulation procedure, it is important that you remain still. You may breathe normally. Once you are positioned correctly, the simulation therapist leaves the room to view your anatomy under fluoroscopy or to take X-rays. The therapist monitors you via a closed-circuit television, and you can communicate with the therapist through an intercom at all times.

Tattoos will also be given to outline the treatment set-up points and ensure accurate delivery of the daily treatments. Tattoos are freckle-like marks that consist of a drop of ink placed under the skin with the tip of a needle. A tattoo is permanent. In addition, marks may also be drawn on your skin in the treatment area using a washable crayon-like pencil. You need to leave these marks on. The therapist will touch them up during the course of therapy. You will be instructed when you can remove the marks.

During the simulation, an identification face photo and set-up photos will be taken for documentation. All of the photos taken during the course of treatment are kept in your confidential medical record.

During the course of your treatments, your physician may want to modify your treatment area. This may require additional simulation procedures. We will notify you in advance so you can prepare your schedule accordingly.

The data from the treatment plan helps the physician determine the amount of radiation needed over the course of your treatment.  In addition, the information from the plan is used to confirm the daily dose of radiation and the total number of treatments you will receive. Based on the area being treated, custom-made lead shields may be necessary to spare healthy organs and tissue from being exposed to the radiation. Your actual treatment will begin after the physician approves the plan, a process which takes several days. You will not be physically present during the planning period.

The Day of Your Treatment

Each day you will check in at the reception desk. The receptionist notifies the staff of your arrival. The radiation therapist will escort you to a private dressing area. You will be instructed to put on a hospital gown and remove all clothes near the treatment site.  The Radiation Oncology Department provides you with a private locker and key. Since you will need to change into a gown for your treatment, it is a good idea to wear loose-fitting clothes. We ask that you remain in the dressing room until the treatment room is ready. A radiation therapist will escort you to the treatment room. Inside the treatment room the radiation therapist will assist you onto the treatment table. During your treatment, your family members may wait for you in the main waiting area. No family members are allowed at the treatment machines. Parents may accompany children to the machine, but will be asked to leave and wait in the main waiting area while the treatment is given.

During the simulation/CT procedure, the simulation therapist placed tattoos on your body pointing out the area that needs radiation treatment. In the treatment room, the treating radiation therapist will position you using those same tattoos with the lasers mounted on the walls and ceiling of the room. The lasers assist the radiation therapist in properly placing your body in the path of the radiation treatment. It is important to remain still when the treatment is being delivered so the tattoos correspond with the lasers at all times. Once you are positioned correctly, the therapist leaves the room to control the machine. The therapist monitors you via a closed-circuit television, and you can communicate with the therapist through an intercom at all times.

Please remember to breathe normally; you do not need to hold your breath. Most treatment sessions are 15 to 20 minutes in duration. You may hear noises from the machine as it delivers the treatment. Please let your therapist know if you have any questions about the machine.

At the completion of your daily treatment, the radiation therapist will assist you off the treatment table, give you an appointment card for the next treatment, and escort you back to the dressing room.

In the event you are unable to come in for a treatment please call the department. We will notify your radiation oncologist and make the necessary adjustments to your treatment schedule. On the occasion that you do not receive five treatments in a week due to a holiday, illness, or inclement weather, the missed treatment will be added to the end of your schedule.

Port films and Status Check

Before your first treatment and weekly during the course of your treatment, you will have special X-rays, called port films, which are used to confirm the accuracy of your treatment position. Port films are not a diagnostic X-rays, meaning they are not used to evaluate the presence or absence of disease. These films will be in addition to your treatment, but are done on the same treatment machine. The initial port film can take up to one hour depending on the complexity of your treatment. Generally, the weekly port films take up to five to 10 minutes in addition to your daily treatments.

Once a week, your radiation oncologist and nurse will see you in an appointment called a status check. You should plan for extra time on the days when they are scheduled. Generally, the appointment takes 15 to 20 minutes. Your physician and/or nurse will discuss your progress and assess any side effects or concerns you may have. During this visit the physician may want to obtain your weight, draw blood work, or order a diagnostic test.

Appointment Scheduling

Radiation treatment appointments are made Monday to Friday 6 a.m. to 11 p.m. Our receptionist phones are forwarded to an answering service after 9 p.m. Monday to Friday. After 9 p.m. we ask that you call the phone numbers for the individual treatment machines.

If at any time you need to speak to a physician or staff member after 9 p.m. Monday through Friday or on weekends for a medical emergency, call 201-996-2000 and ask the Hackensack University Medical Center switchboard operator to contact the attending radiation oncologist on call.

At the completion of your radiation treatments, your physician and/or nurse will discuss any special precautions you may need to take while you are at home. If your physician asks you to return for a follow-up visit to reassess your progress, the receptionist will assist you with an appointment to return at the prescribed time. Most appointments are done within three to four weeks after treatment.

Appointments are made by the appointment coordinator either in person or by phone. The staff works closely with your physician to plan your care. Due to the complexity of the treatments provided in the Radiation Oncology Department and the need to treat some patients emergently, scheduling conflicts may arise requiring your appointment time to be changed or delayed. Our staff will work very hard to try to get you an appointment time that meets your needs.  We will notify you of any delays either by phone or upon your arrival to the department.

Orientation Meeting

The Radiation Oncology Department holds an orientation program the second and fourth Tuesday of every month. The program lasts about an hour and a half and is designed for patients undergoing radiation treatment for the first time. Staff members from the department provide an overview of what you may experience during the course of your treatment. A brief video is shown, and there is plenty of time for questions and discussion. Family members are welcome and are encouraged to attend. Please see the receptionist for dates, times, and locations. If you are unable to attend the orientation, staff members are available to answer your questions and discuss your concerns.

Going Home

Depending upon the type of disease for which you are being treated, your doctor may prescribe chemotherapy and/or radiation therapy as part of your treatment plan.

Transplantation and Radiation Therapy
Not everyone who has a blood or marrow stem cell transplant undergoes radiation therapy, but it can be a very effective treatment for many cancers and blood diseases. If radiation therapy is part of your treatment plan, you will meet the radiation therapy team before your admission for your transplant.

Prior to beginning radiation therapy, you will undergo "simulation," which is a preparation session before your treatment actually begins. Simulation consists of taking several special X-rays and body measurements. These are needed, in some cases, to make lead shields, which are worn during radiation therapy to protect organs that are sensitive to radiation, such as your lungs.

In some cases, radiation therapy is administered before a patient is admitted for his/her transplant. These treatments may be administered to a person's whole body or to the areas of the body that have the disease. They may be administered every day for several weeks or two or three times daily over several days. Each treatment may take from 10 to 30 minutes.

Having radiation treatment is similar to having an X-ray. You will not see, hear, or feel the radiation. You may, however, experience some nausea following the treatments.

Social Services

Oncology social workers help patients and family members adjust to the changes in their lives that cancer may create. This can be done through understanding and addressing emotional issues as well as practical concerns. Support groups, counseling, and relaxation treatments are available to help patients cope with this new challenge. A licensed clinical social worker is on staff to address patient and family needs. Please see any team member for assistance to utilize these services.

Hackensack University Medical Center provides transportation to patients who have no means of transport to daily treatments.  There are restrictions in distance to the medical center and other criteria. Please speak to a social worker directly to discuss this program.

Nutritional Support

Maintaining your nutritional health is a very important part of your cancer treatment. The Radiation Oncology Department has a registered dietitian (also known as a “nutritionist”) on staff to help you manage any nutritional problems that may arise during your treatment. Radiation therapy is designed to kill cancer cells but in the process, some normal cells are also affected, which may cause some eating problems. It is important to remember that while some side effects are common to specific treatment sites, not everyone experiences these side effects to the same degree or even at all.

The nutrition questionnaire that you completed when you registered with the department helps our dietitians identify patients at risk of developing nutritional problems during radiation therapy. The dietitian will work with you individually to ensure that your nutritional needs are being met. This may involve special diet counseling, trying high calorie-protein foods and supplements, or weekly weight measurements.

Be sure to tell you doctor or dietitian if you are taking any vitamin, mineral, herbal, or alternative medicine preparations. While a general multivitamin is perfectly safe, certain combinations and doses should be evaluated. We recommend that supplemental doses of “antioxidants” be avoided during radiation therapy. Common antioxidants are vitamins C, E, A, and beta-carotene and selenium. If you are unsure about the safety of any preparation you are taking or have any nutrition-related questions, ask your radiation therapist, nurse, or doctor to speak to a dietitian.

Billing

Within the Radiation Oncology Department, the total cost for providing radiation oncology services comprises two separate fees; the provider of service bills each separately. 

First is the hospital’s fee, which covers the technical portion of services rendered. This incorporates the actual planning and treatment delivery of services, including staff, equipment, and all supplies involved in the performance of your services.

Second is the physician’s fee. This includes the interpretation, supervision, and management of all services performed by the medical center. The physician specialist is a private practitioner, not an employee of the hospital; therefore, his/her office will bill you separately. The private physician practice does not accept charity care as insurance. Therefore, the billing office should be contacted at 201-487-5859 to discuss payment options.

You will be counseled financially at the time of registration.

For physician billing inquiries call:  201-487-5859
For hospital billing inquiries call:     201-996-3198

Glossary of Terms

Brachytherapy: radiation therapy from radioactive sources inside the body. The radiation oncologist may implant radioactive material directly into the tumor or very close to it. Radioactive sources may also be placed within body cavities.

Consultation: a request made by your referring doctor to make a recommendation for radiation treatment. A written report of the recommendation is sent to your referring doctor. It is at this time that the radiation oncologist discusses your diagnosis, obtains a history and physical, and explains the radiation procedure.

CT scan or CAT scan (computed tomography scan): a computerized X-ray procedure that produces cross-sectional images of the body. The images are far more detailed than X-rays and can reveal disease or abnormalities in tissue and bone. The procedure is usually non-invasive and brief.
 
Dietitian: a registered dietitian will evaluate your nutritional questionnaire and will work with you, your physician, and your nurse to monitor your nutritional status.

Fluoroscopy: a radiologic procedure in which a fluoroscope is used to visually examine the body or an organ. This immediate imaging is used to outline treatment areas as well as areas requiring shielding from radiation.

Immobilization Device: a device that prevents a patient from moving and keeps him/her in the same position during every treatment. Examples may include a face mask, body molds, and leg/arm molds.

Laser: positioning equipment used to project a small red or green beam of light toward the patient during simulation, CT scanning, and the treatment process. This provides the therapists several external reference points in relationship to the position of the center of the treatment field.

Lead Shields: pieces of metal alloy that can be used to shape the radiation beam to block healthy organs and tissue from the direct beam of radiation.

Linear Accelerator: a machine that creates high-energy radiation to treat cancers and other tumors using electricity to form a stream of fast-moving subatomic particles. Also called a mega-voltage (MeV) linear accelerator or a linac.

Masking/Tattoos: see Immobilization Device and Tattoos.

Medical Dosimetrist: a person who plans and calculates the proper radiation dose for treatment. Dosimetrists work under the supervision of a radiation oncologist. The radiation oncologist prescribes the proper dose for treatment; the dosimetrist makes sure that the prescribed dose is delivered by the therapy plan.

Medical Physicist: a person who specializes in the application of physics to all aspects of radiation therapy. The medical physicist advises and/or consults with the radiation oncologist in the use of radiation in the diagnosis, planning, and treatment of patients. This includes planning with externally delivered radiation and the use of internally implanted radioactive sources. The medical physicist is also responsible for quality assurance of the treatment machines.

Nurse: a registered nurse will see you at least once a week with your radiation oncologist to monitor your side effects to treatment, draw blood if indicated, or to administer medication if needed.

Physician: a doctor, see Radiation Oncologist.

Physicist: a person who holds a master’s and/or doctoral degree and ensures that the machines used in radiation therapy administer the right amount of radiation to patients. The physicist works with the radiation oncologist to calculate the proper dose of radiation for individual patients.

Port Film: an X-ray film used for the identification and verification of the ideal treatment field parameters

Radiation: energy carried by waves or a stream of particles. Types of radiation used to treat cancer include X-ray, electron beam, alpha and beta particle, and gamma ray. Radioactive substances include forms of cobalt, radium, iridium, cesium, iodine, strontium, samarium, phosphorus, and palladium.

Radiation Oncologist: a physician who uses high-energy radiation to treat cancer and non-cancerous diseases

Radiation Therapist: a person with special training to work the equipment that delivers the radiation treatments as well as the simulator and CT scanning units

Receptionist: a person who greets you at the front desk. The receptionist notifies the staff of your arrival with an electronic scheduling system.

Simulation: a process involving special X-ray pictures, which is used to plan radiation treatment so that the area to be treated is precisely located and marked.

Simulator: a diagnostic X-ray unit mounted on gantries, which mimics a treatment machine’s range of motion and positions

Social Worker: a person who evaluates your concerns questionnaire, organizes the orientation program, and is available to speak with you to go over any concerns you may have

Status Check: a weekly exam by the radiation oncologist and nurse, which is performed to monitor the side effects of treatment 

Tattoos: permanent marks applied to the skin at the time of simulation or a CT scan. Tattoos are applied with a small needle using India ink.

X-Rays: high-energy ionizing, electromagnetic radiation that can be used at low doses to diagnose disease by taking an image of an area of interest or at high doses to treat cancer

Last updated: 2010-03-11