Innovative Technology

The Cancer Center at Paoli Hospital offers patients the latest technological advances in modern radiation oncology. 

We offer:

• Dimensional Conformal Radiation Therapy
• Intensity-Modulated Radiation Therapy (IMRT)
• Image Guided Radiotherapy (IGRT)
• Respiratory Gating – 4-Dimensional CT
• Partial Breast Irradiation (PBI)/MammoSite®
• Prostate Seed Implantation
• Gynecologic Brachytherapy (HDR)
• Varian 21 EX Linear Accelerators with IMRT/IGRT
• Brachytherapy
• Radioimmunotherapy
• Stereotactic Radiosurgery
• CT Scanners

Dimensional Conformal Radiation Therapy

The Paoli Cancer Center offers three-dimensional (3D) conformal treatment planning and delivery for a wide variety of tumors, including those of the breast, prostate, brain, lung, esophagus and pancreas. The term "Three dimensional" refers to a treatment based on a CT scan of the region to be treated. Computer software is used to determine how the patient will appear from any desired direction. This allows for optimal approaches for the radiation beams. "Conformal" means that the beams are custom shaped to maximize the treatment of the disease while minimizing the radiation given to healthy tissues. A sophisticated device called a multi-leaf collimator in which 0.5cm finger like projections used to “conform” around the tumor and block radiation from entering areas that need protection.

To assist with 3D conformal therapy, we also utilize Image Fusion (pictured below). This allows for the simultaneous use of several medical imaging modalities in the targeting and planning of radiotherapy. CT, MRI image data sets are “fused” to provide the imaging benefits of both technologies into a single indexed 3D data set. At the cancer center, this technology routinely used to better define and understand the disease site. In addition, we are able to fuse correlated PET scans and map areas of metabolic activity otherwise invisible to medical imaging. The result is a finely tuned image set that allows us to plan the most precise and effective treatment possible.

Intensity-Modulated Radiation Therapy (IMRT)

IMRT is a new type of therapy that enables treatment of tumors with higher dose levels, with risks of side effects that are no higher than with 3D conformal therapy, and often lower. The concept is that instead of treating with ordinary beams of radiation, we "paint" the dose where it needs to go, point by point, skipping over healthy tissue. The resulting distribution of radiation allows us to create isolated “hot and cold pockets,” which can provide high doses to the tumors and act as safe harbors for critical normal organs such as the spinal cord or optic nerve.

IMRT if offered to selected patients for whom 3D conformal therapy is likely to have side effects. It often use it to treat head and neck tumors (pictured below) and prostate cancer. We have also used IMRT to treat disease adjacent to the spinal cord, as well as to treat a variety of challenging abdominal cases.

Image Guided Radiotherapy (IGRT)

In modern radiation therapy, accurate placement and shaping of the radiation is crucial. Modren 3D conformal and IMRT therapy depend on precision guidance, making Image Guided Radiotherapy (IGRT) an integral part of our treatment approach. IGRT takes 2D and 3D pictures of the patient, showing the exact location of the tumor and surrounding health tissue in the patient. The therapy machine at the Paoli Cancer center is equipped with on-board imaging systems, the latest advance in treatment technology. On-board imaging enables us to take diagnostic quality x-rays or CT images of patients while they are on the treatment couch and in position for therapy. These images are used to minimize daily changes in patient position. In some cases compensate for the normal shifting of organs within the body as well. IGRT allows us to target soft tissue targets that inside the body from one treatment to the next. Pictured below is rendition of a movement of a actual patient’s bladder and rectal wall after a post prostatectomy over a ten day treatment. This movie was a result of a published IGRT study. The target of the radiation (CTV) must receive dose while sparing the other organs. This would not be possible without IGRT.

 

This technology is offered to the vast majority of our patients on every treatment day. In short, on-board imaging is making a difference in quality of care by improving the accuracy of daily treatments.

 
Varian On-board Imaging ® (OBI)

Daily X-ray films for precise set-up combined with patient
custom immobilization (vac-loc) for on-the-millimeter precision.

Respiratory Gating – 4-Dimensional CT

Accurate delineation of a disease site is crucial to the precise planning and delivery of radiation therapy. However, the body does not always remain still during treatment, and for precise treatment of tumors of the lung or abdomen, even normal respiration can present a challenge. The 4-dimensional CT scanner with respiratory gating technology allows us to address tumor motion in such circumstances. Gating gives us the ability to effectively compensate for tumor motion by operating the radiation beam only when the tumor is in the desired location within the field of view.

GE Multi-slice CT Scanners with Varian RPMTM Respiratory Gating

Four-Dimensional CT Scanner (4D CT)

GE Multi-slice CT Scanners with Varian RPMTM Respiratory Gating

Helical CT scan (3D) with light breathing

4D CT data set

Motion Artifacts In Patients Can Be Addressed With 4D CT

Four-Dimensional CT Scanner (4D CT) 

Motion Artifacts In Patients Can Be Addressed With 4D CT

Partial Breast Irradiation (PBI)

This is a treatment for certain breast cancer patients who have chosen to have breast-conserving surgery (lumpectomy) followed by radiation. The traditional standard of care has been radiation therapy of the entire breast, over a period of 5-6 weeks. This involves some risk of side effects, as well as a large time commitment for the patient. However, for some patients, treatment may be equally effective if High Dose Rate Brachytherapy or HDR methods are used to treat only the area of the breast where the cancer was removed over a period of one week.

This technique is also referred to as MammoSite, which places the radiation source inside a small, soft MammoSite balloon placed in the lumpectomy cavity (the space left when a tumor is removed).

For more information, visit our MammoSite Radiation Therapy page.

Prostate Seed Implantation

In collaboration with Department of Urology, we offer implants of radioactive seeds to patients with prostate cancer. This outpatient procedure takes place in a single day, as opposed to eight weeks for external radiation (3D conformal therapy). Patients can usually resume most normal activity within a few days after the procedure. The seeds stay in place permanently, but do not require any long-term changes in lifestyle. For some patients, this treatment is an attractive alternative to external radiation.

Gynecologic Brachytherapy (HDR)

HDR brachytherapy is a radioactive implant in which the therapeutic radiation dose is given during a short treatment session, usually lasting less than one hour. The treatments are given on an outpatient basis. This technique can replace slower methods involving hospital stays of several days duration. We are currently offering HDR treatment to patients with gynecologic cancers.

Varian 21 EX Linear Accelerators with IMRT/IGRT

Paoli is one of the few cancer centers in the region to offer this technology. Image-guided radiation therapy (IGRT) is a computer-driven technology that delivers a higher dose of radiation more precisely to the tumor, while increasing protection of surrounding organs and tissues from damaging exposure. Intensity-modulated radiation therapy (IMRT) allows for varied radiation intensity, which leads to improved cancer control and survival with fewer side effects.

Brachytherapy

Brachytherapy is an outpatient procedure that involves the implantation of tiny radioactive "seeds" directly into the cancerous site to deliver concentrated radiation. For certain patients with special clinical conditions, it offers additional therapeutic options. This technology utilizes radiation-seed-implant and high-dose-rate (HDR) equipment for the effective treatment of prostate, gynecologic, breast and other cancers.

MammoSite®

While traditional radiation treatment after a lumpectomy radiates the entire breast and can take as long as seven weeks, MammoSite brachytherapy radiation treatment can be completed in as little as five days by delivering a higher dose of radiation directly to the tumor site. 

Radioimmunotherapy

Radioimmunotherapy allows doctors to target and concentrate radiation to specific tumor sites, reducing the amount of radiation that reaches healthy tissue. The technology links radioactive atoms to monoclonal antibodies that deliver the radioactivity by seeking out and latching onto proteins found on cancer cells. These antibodies attach to the cancerous cells and weaken or destroy them with attached radiation.

Stereotactic Radiosurgery

Stereotactic radiation therapy involves targeting a tumor from many different directions so the beams of radiation converge on the tumor. This enables the right amount of radiation needed to destroy tumor cells to be delivered directly to the growth, minimizing the amount of exposure to the area surrounding the tumor. Currently, this type of radiotherapy is used to treat brain cancers, but as the technology evolves, this technique may one day be used to treat tumors in other sites. During the procedure, the patient's head is held perfectly still by a temporary frame surgically attached to the skull. Then, using a map based on images of the tumor and the brain obtained from computed tomography (CT) scans or magnetic resonance imaging (MRI), a movable, computer-guided radiation therapy machine delivers beams of radiation to the brain tumor from many different angles.

CT Scanners

Computed tomography (CT) imaging technology allows us to better and more accurately target and visualize tumors and diseased tissue for greater position and patient convenience.