Tomotherapy, Radiation of the Future

I have to digress a bit to describe Tomotherapy and the process it take to get set up for it.  Tomo is one of the reasons Kim and I decided to go with CTCA because very few cancer centers are using this type of therapy.  It seemed to us a less evasive approach to radiation, especially in the neck and throat, that could cause the least amount of damage to areas like the Salvation Glands, voice box, ears.
Here's a short summery of what Tomo is:

Planning. Before beginning a TomoTherapy treatment, the doctor uses 3D images from a combination of scanning technologies (such as CT and MRI) and special software to establish the precise contours for each treatment volume (tumor) and any regions at risk (sensitive organs or structures). The doctor then decides how much radiation the tumor should receive, as well as acceptable levels for surrounding structures. The TomoTherapy treatment system calculates the appropriate pattern, position and intensity of the radiation beam to be delivered, to match the doctor’s prescription as closely as possible.

Patient positioning. As both a treatment delivery machine and a CT scanner, the TomoTherapy system allows doctors to take a CT scan just before each treatment. With the scan, they can verify the position of the tumor and, if necessary, adjust the patient’s position to help make sure radiation is directed right where it should be.


Precise treatment delivery. The TomoTherapy treatment system delivers radiation therapy with a spiral delivery pattern (TomoHelical^™) or discrete-angle approach (TomoDirect^™). Photon radiation is produced by a linear accelerator (or linac for short), which travels around the patient and moves in unison with a device called a multi-leaf collimator, or MLC, that shapes the beam. Meanwhile, the couch is also moving—guiding the patient slowly through the center of the ring.

What they don't tell you here is the additional step that Head/Neck folks get.  It's the mask.  The above explanation describes the process.  I am now going to fill you in on the parts that the manufacturer of the unit doesn't tell people and is what I went through.

So on Tuesday morning July 17th, I go in to the hospital for what is called Radiation Simulation.  It's the steps needed for the computer, Dr Chang, and a team of radiology techs to determine basically the targeting pattern the machine will take when applying radiation to my body. 

So I go in and they have this machine called a PET/CT.  Looks very similar to the Tomo machine in the picture above.  I lay down on the "board" with my head on a hard rest that keeps my head from moving around.  They hook up an IV with radioactive "juice" and then stick me into the machine so it can scan me.  The oral contrast (the Juice) has both Barium and some high sugar content.  Apparently, cancers like sugars, so when you send the radioactive sugars into the body, the cancers cell suck it up compared to normal cells.  The PET scan then finds these happy Sugar high Cancer cells and records 3D images of them.  This take about 25minutes.  Out I pop like toast from a toaster.

However, I'm not done.  Now the mask.  Nobody said anything about the mask process to me, just that I was going to need a mask.  And I have to where my tooth trays my dentist made up for me during this and all Tomo treatments.  They will keep the radiation from pinging off all my silver fillings I've had over the years.  That made perfect sense to me.  So up I go, put in the guards, and back down onto the table.  Steve the Simulation tech then asks if I am claustrophobic?  I tell him no with a slight air of concern in my voice.  He come back and states that some people kind of freak out on the next part but you're not claustrophobic, you should be fine.  Then he asks if I'm ready to do the mask.  I guess, how bad can this be.  He proceeds to bring over this large heated cross between plastic and fiberglass sheet and lays it on my face, total covering me from chest plate to over my head.  Completely smothering me,

I can't breath and sort of mumble something to Steve, who is quickly molding the plastic sheet around my face, that I can't breath.  "Oh, sorry" he says and quickly moves t model the plastic around my nose so that there is about an 1/16 of an inch separation from my nostrils so I can once again breath.  Steve little art project continues for about another 30 seconds, forming the plastic around my face and neck to get a nice close fit.  He then says "ok, gonna send you back into the PET again to line up your mask for the computer" and zoom, I slide back into the PET for another 20 minutes and the computer scans my mask for 3D alignment.  This time when I slide out, Steve comes over and cautiously removes my mask and states that "I'm done and can leave".  That's it.  See ya in 10 days.  Here's pics of the mask on me getting ready to do a treatment.  They actually lock the bitch down to the table I am lying on to keep my movements to almost nothing.  That way when they do a daily alignment, my position will stay consistant for all of treatment.  I can understand the claustrophobia thing.  Some patient's have to actually be sedated to do this.  I guess I'm weird, I find it facinating and my little sci-fi head makes the whole process like something out of Blade Runner or Total Recall.  

 

Here a side view showing the lock down pins












Here's the top view.  Just because there are holes where my mouth is, my mouth is closed because of the teeth guards.  Breathing is only through my nose.
Notice the green laser aligning tool splitting my forehead in half.  There are red ones on my shoulders as well.





The whole treatment process only takes 20 minutes: 1 min. to lock me down in my mask, 5 minutes to align, 1 minute to align daily with simulation targeting, 17 minutes of actual radiation.  Twice a day; once in the AM around 9am. the seconda minimum of a least 6 hrs later around 3:30/4pm, 5 days a week, weekend off.  And that's where we're at.  Chemo begins this afternoon.  It has finally begun.
(and a great tumultuous cheer rises upward at the start of Treatment,  Yeaaaaaaaaaaaaaaaaaa!!!!!!!!!