Welcome to the Patient/Visitor Guide to Emory Radiation Oncology - we hope the following information will help guide you through our patient treatment cycle.

• Clinical team
• Consultation
• Simulation
• Planning
• Delivery and verification
• Follow-up care

External beam radiation therapy involves following a treatment cycle to achieve results. This section will introduce you to the patient treatment cycle and the Emory process.

A medical doctor who has had special training in using radiation to treat disease--a radiation oncologist--will prescribe the type and amount of treatment that best suits your needs.

• The radiation oncologist works closely with other doctors involved in your care and also heads a highly trained health care team. Your radiation therapy team may include:
• The radiation physicist, who makes sure that the equipment is working properly and ensures that the machines deliver the right dose of radiation.
• The dosimetrist, who helps carry out your treatment plan by calculating the number of treatments and how long each treatment should last.
• The radiation therapy nurse, who provides nursing care and helps you learn about treatment and how to manage side effects.
• The radiation therapist, who sets you up for your treatments and runs the equipment that delivers the radiation.

At Emory University, all of the physicians are board certified and have special areas of interest. They are assisted by a team of physicists devoted to educating the next generation of physicists as well as quality care and the integration of new technology into the treatment of patients, mature radiation therapists who have been with the Department for many years and mastered the intricacies of executing innovative treatment plans, caring and devoted nurses especially knowledgeable in the treatment and the management of radiation side effects, as well as a social worker to counsel and aid in the solution of problems that are often encountered during a long course of treatment. Emory has a training program in radiation oncology and residents and fellows physically assist in the care and treatment of patients supervised by staff physicians, but also act as the conscience of the department by their continually inquiring minds.

The options available to you will depend on a number of factors, including the type of tumor, the extent of the disease at the time of diagnosis, your age, and your medical history. But your personal feelings about the treatment, your self-image, and your lifestyle will also be important considerations in your doctor's assessment and recommendations. You and your radiation oncologist should discuss these treatment methods and how they apply to your situation.

Radiation therapy is an effective way to treat many kinds of cancer in almost any part of the body. Half of all people with cancer are treated with radiation, and the number of cancer patients who have been cured is rising every day. For many patients, radiation is the only kind of treatment needed. Thousands of people are free of cancer after having radiation treatments alone or in combination with surgery, chemotherapy, or biological therapy.

Doctors can use radiation before surgery to shrink a tumor. After surgery, radiation therapy may be used to stop the growth of any cancer cells that remain. Your doctor may choose to use radiation therapy and surgery at the same time. This procedure is known as intraoperative radiation. In some cases, doctors use radiation along with anticancer drugs to destroy the cancer, instead of surgery.

Even when curing the cancer is not possible, radiation therapy still can bring relief. Many patients find the quality of their lives improved when radiation therapy is used to shrink tumors and reduce pressure, bleeding, pain, or other symptoms of cancer. This is called palliative care.

After a physical exam and a review of your medical history, the radiation oncologist may need to do some special planning to pinpoint the treatment area. In a process called simulation, you will be asked to lie very still on a table while the radiation therapist uses a special x-ray machine to define your treatment ports or fields. This is the exact place on your body where the treatment will be aimed. You may have more than one treatment port. Simulation may take from a half hour to about 1 hour.

At Emory University, we use a high-tech simulation process called CT Simulation. This method is superior to conventional simulation offered in most hospitals. The CT simulation system offers high-resolution imaging and short examination time for the full range of oncologic procedures including volumetric localization, simulation and verification for conformal, high-precision and stereotactic radiotherapy planning. Click here to see a typical CT simulation process...

There are four main components that comprise Emory's CT Simulator System: the CT scanner, an integrated laser system for patient marking and localization, and a virtual simulator capable of producing real-time digitally composited radiographs (DCRs). Click here to see the components of our CT Simulator...

Using the information from the simulation, other tests, and your medical background, your doctor will meet with the radiation physicist and the dosimetrist.

Your doctor then decides how much radiation is needed, how it will be delivered, and how many treatments you should have. This process often takes several days.

At Emory University, we use a process called Three-Dimensional (3-D) Treatment Planning to design and optimize the radiation therapy treatment for patients. This treatment planning computer software allows doctors to view a patient's tumor three-dimensionally, enabling them to judge the most effective strength of the electron treatment beam used while minimizing damage to the healthy tissues surrounding the tumor. It is the latest planning technology available and is revolutionizing the way radiation treatment planning is performed. 3-D conformal therapy techniques to the prostate, lunch esophagus, and small tumors of the head and neck are also using the 3-D treatment planning computer. Click here to see our treatment planning systems...

The radiation used in radiation therapy can come from a variety of sources. Your doctor may choose to use x-rays, an electron beam, or cobalt-60 gamma rays. Choosing which type of radiation to use depends on what type of cancer you have and on how deep into your body the doctor wants the radiation to penetrate. High-energy radiation is used to treat many types of cancer. Low-energy x-rays are used to treat some kinds of skin diseases.

After you have started the treatments, your doctor will follow your progress, checking your response to treatment and your overall well-being at least once a week. The treatment plan may be revised by your doctor, if needed. It's very important that you have all of your scheduled treatments to get the most benefit from your therapy. Unnecessary delays can lessen the effectiveness of your radiation treatment.

Our department has two Varian linear accelerators, both equipped with multi-leaf collimation, electronic portal imaging, and quality control software to avoid errors in treatment. There is capability to treat with low and high dose photons as well as a whole range of electrons. We use multi-leaf collimators (MLCs) to custom shape the radiation field to match the tumor dimensions while sparing normal tissue. The linear accelerators are all computer controlled. In addition, we provide electronic portal imaging to verify the treatment was delivered correctly. Click here to see the main equipment in our treatment delivery systems...

The treatment delivery process is performed on a daily basis. It involves lying on a treatment couch with some body immobilization system. The linear accelerator is properly positioned and the radiation therapist uses the computer-controlled interface to deliver the treatment. On-line portal imaging verification is performed to ensure the correct delivery of radiation dose to the tumor site. Click here to see the five steps in the treatment delivery process...

Once your course of radiation therapy is finished, it is important to have regular exams to check the results of your treatment. No matter what type of cancer you've had, you will need regular checkups and perhaps lab tests and x-rays. The radiation oncologist will want to see you at least once after your treatment ends. The doctor who referred you for radiation therapy will schedule follow-up visits as needed. Follow-up care, in addition to checking the results of your treatment, might also include more cancer treatment, rehabilitation, and counseling. Taking good care of yourself is also a part of following through after radiation treatments.

Most patients return to the radiation oncologist for regular follow-up visits. Others are referred back to their original doctor, to a surgeon, or to a medical oncologist, a doctor who is trained to give chemotherapy (treatment with anticancer drugs). Your follow-up care will depend on the kind of cancer you have and on other treatments that you had or may need.