• Prescription for Radiation
• Service Options In-Brief
• The New Facility Includes
• More Facts

After a two-year-plus construction process that saw workers burrow deep underground before piecing together a structure that climbed impressively skyward, the new Center of Excellence in Image-Guided Radiation Therapy, a component of Holden Comprehensive Cancer Center, opens in June.

Specializing in the delivery of image- and optic-guided stereotactic radiation, the Center houses machines that lock on cancer sites with pinpoint accuracy and minimize contact with patients' healthy tissue. The precision targetingÑtreatment can be delivered to within 0.7 millimeters rather than the traditional five to 15 millimetersÑis facilitated by sophisticated computer imaging equipment that creates three-dimensional representations of the patient.

The technologies permit quicker, higher doses of radiation to the patient's cancer, reducing side effects and in some cases eliminating the need for traditional surgery.

"Patients will find these methods more convenient and will tolerate them better, too," said John Buatti, M.D., professor and head of the Department of Radiation Oncology. "This will be a major step forward in our efforts to curb the suffering and death of our cancer patients."
John Buatti, M.D.

"We were already doing many of the things in our old space that we're doing in the new facility, but as technology and the general requirements for providing top-notch treatment evolved, we began to top out as far as what we could offer in the old facility," said Laurie Smith, administrator for the Department of Radiation Oncology. "We had outgrown the space. We couldn't fit the latest equipment into it, and we couldn't be as comprehensive with the treatments offered. We see this move as an opportunity to get a new base and grow from there."

Prescription for Radiation
When cancer patients come to the UI Department of Radiation Oncology's Center of Excellence in Image-Guided Radiation Therapy, they meet with a multidisciplinary team that includes specialists from medical oncology, radiation oncology, radiology, nuclear medicine, and pathology, to determine the best treatment path. Computer images of the patient's tumor, called simulations, are made and may include merging positron-emission tomography (PET), computerized tomography (CT), and magnetic resonance imaging (MRI) scans.

The imaging information is sent to physicists and dosimetrists (staff who perform calculations to ensure the tumors receive the prescribed radiation dose), who then create a computerized, virtual model of the patient. This model tests various angles of approach, radiation beam sizes, and radiation levels to plot a highly accurate radiation delivery map. Treatment planning can be completed the same day or take up to a week, depending on the type of treatment, complexity, and location of the tumor.

When the patient is ready for treatment, the computer model of the tumor is sent to one of four on-site Siemens Oncor LINAC (linear accelerator) machines, which deliver the radiation. Certified radiation therapists carry out the treatments.

An infrared positioning system links the patient treatment plan in the computer to the actual patient in real-time. Using real-time images obtained in the treatment room, direct infrared feedback linked to the patient establishes a concept called "stereotactic guidance" to improve accuracy.

The treatment is delivered through an automated and computer-controlled sequence that conforms to the individual patient's tumor size and shape. Linear accelerators rotate around the patient and automatically shape a radiation beam in synch with the computerized treatment plan. The LINAC machines can deliver two to seven or more beams of radiation to the cancer site, depending on the patient's carefully plotted treatment "prescription."

Patients generally receive radiation for six to seven weeks, five days a week. No weekends. Normal tissue, while spared as much as possible, needs time to repair; tumor tissue is not as effective in repairing itself hence the daily treatments ae required for some types of tumors.

Service Options In-Brief

• Intensity modulated three-dimensional (and soon to be four-dimensional) radiotherapy
• Radiosurgery: Unique patents held by specialists at Holden Comprehensive Cancer Center make radiosurgery less invasive for patients with many types of brain tumors. This technology makes it possible to deliver one-time or multi-treatment radiation doses to precisely targeted areas
• Ultrasound guided extracranial radiosurgery: This treatment combines 3D ultrasound and computer guidance to minimize damage to tissue surrounding tumors for treatments outside of the patient's skull
• HDR brachytherapy: HDR delivers a radioactive source directly to the patient's tumor site quickly, with precision and little radiation, without requiring an overnight hospital visit
• Interstitial seed implantation of the prostate, endobronchial and endobiliary implants, intracavitary brachytherapy applications, plaque therapy for malignant melanoma, endovascular brachytherapy, total skin electron therapy, three dimensional treatment planning, and intensity modulated radiotherapy

The New Facility Also Includes:

• The Cancer Information Service, offering personal computers, Internet access, videos, and literature for patients to learn more about their disease, information on clinical trials, and information on oncology support services.
• Larger patient exam areas enabling multidisciplinary experts from different departments to consult with patients. Family reception areas provide a comfortable Ôhomey' atmosphere. This benefits patients who spend a full day in the department.
• Pediatric play areas feature bright, warm colors and include a television, VCR, games, and toys.
• VIP Services staff members ensure that patients have convenient access to worry-free parking. The building, located on the west side of the Pomerantz Family Pavilion at UI Hospitals and Clinics (across from Kinnick Stadium), will include a range of clinical facilities, but the Department of Radiation Oncology and its Center of Excellence are the first occupants. The Center encompasses approximately 40,000 square feet of the six-story, 218,000-square-foot structure, whose design also provides space for future growth and upcoming technologies.

More Facts

• The building's excavation was 68 feet deep, or approximately 10,700 truckloads of dirt.
• 18,375 cubic yards of concrete had been poured as of late April, with 1,726 tons of concrete reinforcement.
• The treatment area is extensively shielded by thick walls of concrete and is underground to ensure maximum protection from radiation. The treatment rooms have 706,000 pounds of lead shielding; walls range from 18 inches to seven feet thick.
• The HDR therapy room has 213,000 pounds of protective lead shielding.
• The building is capable of supporting four more levels.

John Buatti, M.D.

For more information:

Holden Comprehensive Cancer Center

Department of Radiation Oncology

Cancer Information Service