Scans during radiation for re-planning

adrian b

Question for everybody. Has anyone had any scans half way through their radiation treatment for re-planning purposes and was it a worth while exercise? The reason I ask is, I start my 3rd week of radiation treatment tomorrow and I have also been booked in for an MRI and then CT scan the following day.

The reason my radiation oncologist wants to do this is to try and increase the margin for treatment near my brain stem (currently at 3mm). I have been told the brain stem can handle up 56 gy, currently mine is at 58 gy with the 3mm margin so the hope is that the extra round of chemo and the radiation thus far has shrunk the tumor further to increase the margin and lower the dosage (first two rounds of chemo shrunk it by 1/2).

I am a little sceptical as I have been told that it is often difficult to differentiate on the scans while doing radiation treatment. I am more than happy to do the scans to see what they can tell us but a little concerned about what to do about the results. Has anyone else gone through re-planning half way through treatment?
Adrian

Jimbo55

Scans during treatment
Adrian, I also had a scan during my rad/chemo treatment, as have others on this forum. It was used to check the effectiveness of the treatment and based on the decreased size of the tumor, they then adjusted the settings of the radiation treatment. I believe this is a fairly standard practice during treatment. Cheers.

Jimbo

Pam M

Jimbo55 said:

Scans during treatment
Adrian, I also had a scan during my rad/chemo treatment, as have others on this forum. It was used to check the effectiveness of the treatment and based on the decreased size of the tumor, they then adjusted the settings of the radiation treatment. I believe this is a fairly standard practice during treatment. Cheers.

Jimbo

I got checked, too
Seemed like "standard" at my center

Skiffin16

Additional Scans
I too had additional scans....

I would get an X-Ray each week on Monday during the rads sessions. More so for fit and effectiveness of the mask.

I also had a CT during that concluded the lump (secondary) area had actually shrunk and dissolved away.

So like mentioned above, it seems to be fairly common.

Best,
John

Redbanker

IMRT Tomotherapy
Even after reading this board for many months, I'm not sure to what extent IMRT Tomotherapy is the way most people now go. This is how my partner was treated (just completed 6/28)and each of his 33 treatments was preceded by a CT scan--the scanner is built into the machine and seems to controvert my mother's maxim that you should never buy anything that claims to do two things because it will do neither of them well.

Regards,

Nancy

jim and i

Redbanker said:

IMRT Tomotherapy
Even after reading this board for many months, I'm not sure to what extent IMRT Tomotherapy is the way most people now go. This is how my partner was treated (just completed 6/28)and each of his 33 treatments was preceded by a CT scan--the scanner is built into the machine and seems to controvert my mother's maxim that you should never buy anything that claims to do two things because it will do neither of them well.

Regards,

Nancy

Jim has not had any scans,
Jim has not had any scans, except last week to check for an abscess. I wonder if we should ask about it?

Skiffin16

Redbanker said:

IMRT Tomotherapy
Even after reading this board for many months, I'm not sure to what extent IMRT Tomotherapy is the way most people now go. This is how my partner was treated (just completed 6/28)and each of his 33 treatments was preceded by a CT scan--the scanner is built into the machine and seems to controvert my mother's maxim that you should never buy anything that claims to do two things because it will do neither of them well.

Regards,

Nancy

Nancy, welcome to the forum....

I had the IMRT, and the machine does do X-Rays (once a week for me)...

I'm willing to bet, that your machine can and does do X-Rays but that it doesn't do CT's.

The X-Ray adds an additional 5 minutes or so and like I said, for me that was once a week.

As for a CT, I can almost guarantee the IMRT does not do a CT..

First, it isn't built to do a scan that way. A CT machine takes a good 15 - 30 minutes and is a 3D imagine producer, the IMRT delivers a concentrated radiation dose to specifically desginated areas.

This would mean the IMRT machine was doing a CT Scan and IMRT radiation simultaneously. Which again contradicts the method of the machine...a CT machine being round doesn't rotate in the same manner that a IMRT machine does. Lastly, you are injected with the contrast when doing a CT, initially then half way through the treatment.

I believe you might be mistaking the X-Ray for a CT, and again, that's only usually done once a week.

Best,
John

jeepman

Had a few of them during treatment
I think this is fairly common to have done during treatment. My RADONC conducted a few during treatment, starting at the half way point, to gauge where he need to concentrate the fields of the IMRT based on how the cancer was responding to treatment. I had them a frequently as twice a week in the last two weeks.

No worries, just roll with it.

Mike

Redbanker

Skiffin16 said:

Nancy, welcome to the forum....

I had the IMRT, and the machine does do X-Rays (once a week for me)...

I'm willing to bet, that your machine can and does do X-Rays but that it doesn't do CT's.

The X-Ray adds an additional 5 minutes or so and like I said, for me that was once a week.

As for a CT, I can almost guarantee the IMRT does not do a CT..

First, it isn't built to do a scan that way. A CT machine takes a good 15 - 30 minutes and is a 3D imagine producer, the IMRT delivers a concentrated radiation dose to specifically desginated areas.

This would mean the IMRT machine was doing a CT Scan and IMRT radiation simultaneously. Which again contradicts the method of the machine...a CT machine being round doesn't rotate in the same manner that a IMRT machine does. Lastly, you are injected with the contrast when doing a CT, initially then half way through the treatment.

I believe you might be mistaking the X-Ray for a CT, and again, that's only usually done once a week.

Best,
John

Tomotherapy
Hi John,

Here's a quick 411 on Tomotherapy -- it's from Wikipedia so I wouldn't necessarily write a check on this account, but it conforms to what our radiologist told us

TomoTherapy "beam on" times are comparable to normal radiation therapy treatment times (about 3–5 minutes beam on time for a common prostate treatment) but do add an additional 2–3 minutes for a daily CT. The daily CT is used to precisely place the radiation beam and allows the operator to modify the treatment should the patients anatomy change due to weight loss or tumor shrinkage (adaptive radiotherapy). Lung cancer, head and neck tumors, breast cancer, prostate cancer, stereotactic radiosurgery(SRS) and stereotactic body radiotherapy (SBRT) are some examples of treatments commonly performed using TomoTherapy. While the first clinical use of TomoTherapy was in 2002, at the University of Wisconsin, under the leadership of Dr. Minesh Mehta, M.D., there are now more than 300 sites across Canada, the United States, Europe and Asia.

And thanks for the welcome. You are one of my heroes.

Nancy

Hondo

Hi Adrian
Me too all during treatment had a lot of scans to help the Dr understand how the treatment is working. Hope you continue doing well and welcome to the family

Hondo

Skiffin16

Redbanker said:

Tomotherapy
Hi John,

Here's a quick 411 on Tomotherapy -- it's from Wikipedia so I wouldn't necessarily write a check on this account, but it conforms to what our radiologist told us

TomoTherapy "beam on" times are comparable to normal radiation therapy treatment times (about 3–5 minutes beam on time for a common prostate treatment) but do add an additional 2–3 minutes for a daily CT. The daily CT is used to precisely place the radiation beam and allows the operator to modify the treatment should the patients anatomy change due to weight loss or tumor shrinkage (adaptive radiotherapy). Lung cancer, head and neck tumors, breast cancer, prostate cancer, stereotactic radiosurgery(SRS) and stereotactic body radiotherapy (SBRT) are some examples of treatments commonly performed using TomoTherapy. While the first clinical use of TomoTherapy was in 2002, at the University of Wisconsin, under the leadership of Dr. Minesh Mehta, M.D., there are now more than 300 sites across Canada, the United States, Europe and Asia.

And thanks for the welcome. You are one of my heroes.

Nancy

Hmmm - I Stand Corrected.... :}
You are correct in referencing the IMRT TomoTherapy;

Intensity Modulated Radiation Therapy (IMRT)

This advanced therapy shapes beams of radiation to the exact contour of a tumor, helping to protect healthy tissues that surround the tumor. IMRT is revolutionizing the way that head and neck cancers, including throat cancer, are irradiated. With cancers of the tongue, throat and larynx, the lymph glands of the neck typically have to be radiated along with the cancerous tumor. This often results in permanent damage to salivary glands and a life-long dry mouth. However, IMRT makes it possible for cancer doctors to treat the lymph nodes in your neck and avoid your salivary glands during throat cancer treatment. Not so sure on that last statement, LOL....

TomoTherapy

Because of its remarkable accuracy, this special form of IMRT allows us to safely retreat tumors in areas of the throat that are extremely hard to reach. TomoTherapy® integrates imaging technology with radiation therapy. Each time you receive a TomoTherapy® throat cancer treatment, you will first undergo a CT scan from the same machine. Just minutes after the CT scan is taken, radiation therapists make technical adjustments to the system to align your programmed radiation treatment to the precise position you are in.


Apparently these are two different types of machines (I believe)...

I had the IMRT, but not with the TomoTherapy. I did have X-Rays once a week....and traditional CT scans in the machine same machine (or similar) to that in which I get the PET Scan..each with a contrast injected first.

I'll have to ask about the IMRT/TomoTherapy machine...

I know they just purchased a newer type of PET Scan machine, looks like two butted up next to each other. It also cuts the contrast down 30% and the time of the scan itself by 30%.

Always glad to learn of newer technology....even old dogs can learn something new.

And thank you for the compliment...

Don't think of myself as a Hero, but I do hope that I can help others and try to do it with a straight on approach. Sometimes people like that, sometimes they don't....but at least I try to be consistent, LOL...

Best,
John

adrian b

Hondo said:

Hi Adrian
Me too all during treatment had a lot of scans to help the Dr understand how the treatment is working. Hope you continue doing well and welcome to the family

Hondo

Thanks everyone
Thank you all for responding to my post. Just had the MRI done and meet with the rad/onc tomorrow to review the results. Did you all have your MRI's with your rad mask on? They struggled to try and fit it while I was on the MRI machine but got their eventually.

For the others who posted about the Tomo machine, that is what I am receiving my treatment on. Was told this morning that it is the only one in Australia, though more are on order.

Skiffin16

adrian b said:

Thanks everyone
Thank you all for responding to my post. Just had the MRI done and meet with the rad/onc tomorrow to review the results. Did you all have your MRI's with your rad mask on? They struggled to try and fit it while I was on the MRI machine but got their eventually.

For the others who posted about the Tomo machine, that is what I am receiving my treatment on. Was told this morning that it is the only one in Australia, though more are on order.

CT with Mask
During my initial CT or PET, I did have the mask on for about 10 minutes or so at the end. Mainly checking fit and sort of a trial run also.

Best,
John