Important Steps for Important Steps for Radiation PlanningRadiation Planning

Dr Surendra Singh Solanki MDDr Surendra Singh Solanki MDConsultant, Radiation OncologyConsultant, Radiation Oncology

““BA” Smt. L. C. Parikh Cancer CentreBA” Smt. L. C. Parikh Cancer CentreNavsari, 396445 Gujrat.Navsari, 396445 Gujrat.

Worked At – Worked At – Rajiv Gandhi Cancer Institute & Rajiv Gandhi Cancer Institute &

Research Centre, New DelhiResearch Centre, New Delhi

Day 0Day 0

1.1. OPD RegistrationOPD Registration

2.2. File Process (History + Examination)File Process (History + Examination)

3.3. Radiation Treatment DiscussionRadiation Treatment Discussion

4.4. How the work is done in this Hospital?How the work is done in this Hospital?

Day Day 0-0- File Process- History File Process- History

Original complaintsOriginal complaints Past history, AddictionsPast history, Addictions First examination from record First examination from record Previous CT/MRI Scan, X- ray, USGPrevious CT/MRI Scan, X- ray, USG Biopsy reportBiopsy report Previous treatment details- Surgery, Previous treatment details- Surgery,

Chemotherapy, RadiotherapyChemotherapy, Radiotherapy Histo-Patho-Report Histo-Patho-Report

Doctor is writing your details in file

Day 0- Patient’s ExaminationDay 0- Patient’s Examination

..

Doctor is doing patient’s examination

Day 0- Radiation Treatment Day 0- Radiation Treatment DiscussionDiscussion

External Beam Radiation TherapyExternal Beam Radiation Therapy.. Indication to give Radiation TherapyIndication to give Radiation Therapy Post OP SettingPost OP Setting: 60 Gy/30# @ 1.8 -2Gy/# : 60 Gy/30# @ 1.8 -2Gy/#

once a dayonce a day Radical EBRTRadical EBRT: 66-70Gy/33-35# @ 1.8-2Gy/# : 66-70Gy/33-35# @ 1.8-2Gy/#

once a dayonce a day Palliative EBRTPalliative EBRT: 30 Gy/10# @ 3Gy/#: 30 Gy/10# @ 3Gy/# All plan in phased manner-PH1, PH2, PH3 etcAll plan in phased manner-PH1, PH2, PH3 etc

Mon to Fri 5 days a week for 6 to 7 weeksMon to Fri 5 days a week for 6 to 7 weeks Daily Treatment time 10 to 30 minutes. Daily Treatment time 10 to 30 minutes.

(Depending on plan and calculations)(Depending on plan and calculations) New patient set up- 1 hour approxNew patient set up- 1 hour approx

Day 0- Radiation Treatment Day 0- Radiation Treatment DiscussionDiscussion

Expected Results – To reduces the chance of Expected Results – To reduces the chance of recurrence to minimal levelsrecurrence to minimal levels..

Side effects- Mucositis, Skin reactions, Dry Side effects- Mucositis, Skin reactions, Dry mouth, Alopecia (starts from 3mouth, Alopecia (starts from 3rdrd week week onwards, better managed with specific onwards, better managed with specific medications)medications)

Day 0- Radiation Treatment Day 0- Radiation Treatment DiscussionDiscussion

Weekly OPD Visit with Blood test. Weekly OPD Visit with Blood test. (after every 5#) (after every 5#)

Management of Side effects.Management of Side effects. Weekly Chemotherapy as required.Weekly Chemotherapy as required. Radiation Therapy in Day care only.Radiation Therapy in Day care only.

Day 0- Radiation Treatment Day 0- Radiation Treatment DiscussionDiscussion

When Radiation Therapy is When Radiation Therapy is decided.decided.

CT Scan Room- Immobilization cast + scan CT Scan Room- Immobilization cast + scan

Three RoomsThree Rooms

Treatment Planning Room. –Treatment Planning Room. – Tumor marking by Radiation Doctor and Tumor marking by Radiation Doctor and Radiation beam planning by Medical Physicist Radiation beam planning by Medical Physicist

Linear Accelerator Room: Treatment delivery Linear Accelerator Room: Treatment delivery by Radiation Technologist by Radiation Technologist

CT Scan Room (9AM- 12PM)CT Scan Room (9AM- 12PM)

Day 1 - Cast MakingDay 1 - Cast Making

Thermoplatic Material

Day 1 - Cast MakingDay 1 - Cast Making

30 min to 1 hour30 min to 1 hour

Day 1 - Cast MakingDay 1 - Cast Making

30 min to 1 hour

Day 1- Marking and CT ScanDay 1- Marking and CT Scan

Day 1- Marking and CT ScanDay 1- Marking and CT Scan

Day 1-2 Day 1-2 ContouringContouring

“Your Old CT Scan is must for Marking Tumour”

Day 1-2 Day 1-2 ContouringContouring

Day 1-2 Day 1-2 Planning- Beam Arrangements Planning- Beam Arrangements

Day 1-2 Day 1-2 Planning- Total plan sum Planning- Total plan sum

Day 1-2Day 1-2 Planning- Total Dose Distribution Planning- Total Dose Distribution

Maximum Dose to Tumor and minimum dose to normal structure

Varian’s Clinac iX Linear Varian’s Clinac iX Linear Accelerator with IMRT Accelerator with IMRT

•Working from 9AM to 6PM evening •New Patient :- 2PM to 3PM

Varian’s Clinac iX Linear Varian’s Clinac iX Linear Accelerator with IMRT Accelerator with IMRT

Day 3 or 4 Day 3 or 4 Set up for New PatientSet up for New Patient

Time 2PM to 3PM

Mr Amol. Mr Vinayak(heart of this centre)

Every patient one CastEvery patient one CastMonday to Friday (5 days a week)Monday to Friday (5 days a week)Treatment time 10 to 30 minutes.Treatment time 10 to 30 minutes.

““Let’s we all people of Let’s we all people of Radiation unit help you Radiation unit help you

in this centre”in this centre”