Our board-certified radiation oncologists, Dr. Robert Kyler, Dr. David Morgan, and Dr. Heather Morgan direct the patient simulation, contour the tumor and normal structures, collaborate with the dosimetrist and physicist in treatment planning, closely supervise daily treatment delivery and meet with their patients at least weekly during treatment.
The radiation oncologists may review films or cone beam CT scans before treatment to ensure that the patient is positioned accurately and that the target area is receiving the prescribed radiation dose. This review may be done in real time, not later in the day after treatments are completed.
The radiation oncologists rotate their days in the office, which gives each physician the opportunity to know each patient and collaborate in the development of each patient’s treatment plan. Treatment planning is the process of determining the target and optimizing the technique for radiation delivery.
CT Simulation and Treatment Planning
At the Sentara RMH Hahn Cancer Center, we have CT simulation. Typically the patient spends an hour in the simulator room. During this time, a team composed of radiation therapy technicians, dosimetrist, and a physician determines the optimal patient position for treatment, makes customized immobilization devices to ensure accuracy of daily positioning, and obtains a CT scan in the treatment position.
After the patient leaves, we begin an intensive computerized planning process. The patient's planning CT images are transferred to either the Eclipse® treatment planning software or the Hi-Art® treatment planning software. We have the ability to fuse the planning CT images to previous PET scans or MRI scans to enable the physician to more accurately identify the tumor to be targeted. Then our team determines the best treatment plan, including a comprehensive analysis of the location of the cancer and normal patient anatomy. A treatment plan, with various beam angles, radiation energies and doses are chosen to treat the target area and ensuring optimal protection of surrounding healthy organs and tissues.
The Radiation Therapy Department is equipped with the most up-to-date technology, including a new Varian Trilogy® linear accelerator and Hi-Art® treatment system by TomoTherapy®. Both machines are sophisticated tools of modern medicine which produce radiation beams to treat cancer. Both machines provide Intensity Modulated Radiation Therapy (IMRT). IMRT shapes the radiation beam to conform to the tumor itself with higher doses of radiation while sparing the surrounding healthy tissue and reducing side-effects. Both machines also have Image Guided Radiation Therapy which assures the correct positioning on the table and confirms the location of the tumor prior to each treatment if necessary. The radiation therapist, under the direct supervision of the Radiation Oncologist can adjust the location of the prescribed radiation dose on the spot to ensure the most optimal targeting of the tumor on a daily basis.
The department has also added another Varian machine to deliver brachytherapy to patients in the ambulatory setting. Brachytherapy is the placement of radioactive sources into tumors or into areas of the body at risk for tumor recurrence. This is commonly used in the management of gynecologic cancers and early breast cancers. Because the radiation is delivered in just a few minutes rather than over a 2-3 day period, HDR brachytherapy allows us to deliver the treatment without admitting patients to the hospital, although patients may require anesthesia through the Outpatient Surgery Center for placement of brachytherapy applicators for the treatment of cervical cancer.