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Radiation Oncology

BMC's state-of-the-art Radiation Oncology services offer:



CyberKnife delivers highly targeted beams of radiation directly into tumors, in a pain-free, non-surgical way. Guided by specialized imaging software, we can track and continually adjust treatment at any point in the body, and without the need for the head frames and other equipment that are needed for some other forms of radiosurgery.

Three-Dimensional Conformal Radiation Therapy

Three-Dimensional Conformal Radiation Therapy

Three-dimensional (3-D) conformal radiation therapy is based on a CT scan of the region of the body being treated. Radiation oncologists use computer software to determine how the patient will look from any angle and identify the best paths to direct the radiation. The beams are specially made to maximize the effects of the radiation on cancer cells while minimizing its effect on surrounding healthy tissue. A multileaf collimator (a piece of equipment that is capable of blocking radiation) is used to protect areas that could potentially be harmed by the beams. Image Fusion technology, which allows several medical imaging modalities to be used simultaneously to aid in the targeting and planning of radiation therapy, is utilized to assist with three-dimensional conformal radiation therapy. This is routinely used at the Cancer Care Center to better define and understand the disease site. In addition to fusing CT and MRI 3-D data sets, physicians also fuse correlated PET scans and map areas of metabolic activity otherwise invisible to medical imaging. The end result is a finely tuned image set that allows the team to plan the most precise and effective treatment possible.



Intensity-Modulated Radiation Therapy (IMRT) is a type of external beam radiation therapy that delivers beams of radiation customized to the shape and size of the tumor. Unlike 3D-CRT, which delivers the same amount of radiation to both the tumor and the surrounding tissue, the intensity of the beams can be adjusted (modulated) for IMRT, enabling the radiation oncologist to deliver different amounts of radiation to different areas of the tumor and the surrounding tissue. This allows the radiation oncologist to deliver the maximum amount of radiation to the tumor while sparing the surrounding healthy tissue.



Image-guided radiotherapy (IGRT) is used together with three-dimensional conformal radiation therapy, intensity-modulated radiation therapy, and CyberKnife radiosurgery to improve the accuracy of each daily radiation treatment. In modern radiation therapy, accurate placement and shaping of the radiation beams is essential. IGRT uses special imaging technology, such as x-rays and cone beam CT (a compact, faster version of a regular CT that is attached to the linear accelerator and uses a cone-shaped x-ray beam), to take x-ray images before treatment to ensure the most accurate setup prior to treatment delivery. The radiation oncologist uses these images to adjust for daily changes in patient position and, in some cases, the normal shifting of organs within the body. Most patients benefit from this technology every day they receive treatment.

Respiratory Gating

Respiratory Gating

The body does not always remain still during treatment, and for precise treatment of tumors of the lung or abdomen, even normal breathing can present a challenge. In these cases, respiratory gating, also known as 4-Dimensional CT, is used. The four-dimensional CT scanner, equipped with respiratory gating technology, addresses tumor motion during the process of radiation planning. Movements of the tumor can be taken into account, so the radiation beams can encompass the tumor in all phases of the breathing cycle.



Also known as internal radiation therapy, brachytherapy delivers radiation directly into the tumor (called interstitial brachytherapy) or into a surgical cavity or body cavity near it (called intracavitary brachytherapy). By delivering the radiation directly into the tumor or into a nearby cavity, the radiation only needs to travel a short distance, causing less damage to the surrounding normal tissue. Radioactive material is sealed in a delivery device called an “implant.” The implant is inserted into the body using an applicator (often a hollow tube called a catheter). Imaging tests, such as x-rays, CT scans, or MRI scans, are used to guide the radiation oncologist in placing the implant. Depending on the location of the tumor or cavity, the patient will receive either general anesthesia (drugs used to put the patient into a deep sleep) or local anesthesia (drugs used to numb the area being treated). Implants can be permanent or temporary. For high-dose-rate (HDR) treatment, the radiation oncologist places high-dose implants into the tumor or cavity for a short period of time (generally less than one hour) and then removes them. HDR treatment is given on an outpatient basis and may be repeated over several days or several weeks. Currently, HDR treatment is offered to patients with gynecologic cancers, such as cervical cancer, endometrial (uterine) cancer, uterine sarcoma (cancer of the muscle and supporting tissues of the uterus), and vaginal cancer.

What to Expect for Patients


The first step is a consultation with a radiation oncologist who works closely with other physicians and medical professionals to coordinate the best possible care for every patient.

Upon arrival, patients are met by a nurse who will bring them to an exam room, ask for a list of current medications, and collect a brief medical history. During a meeting with his or her radiation oncologist, the patient will answer additional questions; have his or her medical records, x-rays, and test results reviewed; and undergo a physical exam. Afterwards, the radiation oncologist will discuss treatment options with the patient in detail and explain radiation treatment and its potential side effects. If additional testing is necessary, it will be arranged.

Patients are encouraged to bring a family member or loved one with them to their consultation appointment. They are encouraged to ask questions and voice concerns. It's a good idea to bring a list of questions to this visit.

Before the consultation is over, the patient will be scheduled for his or her treatment planning session (also known as simulation) and will be given additional information and instructions to take home.


After the consultation, the patient returns for a treatment planning session, also known as simulation. If there are any instructions the patient needs to follow prior to coming to this appointment, they will have been given to him or her at the initial consultation.

During simulation, the physician and radiation therapist work together to plan the patient's treatment. Many simulations are performed using the department's CT scanner. The therapist will position the patient on the treatment table and create custom immobilization devices specific to his or her body and treatment site. This is done to help the patient maintain the exact same position throughout each daily treatment. It is essential that radiation treatments be precisely targeted. Therefore, it is important that the patient remains as still as possible during treatment.

Marks may be drawn on the patient's skin to outline the treatment area, and small permanent tattoos, the size of a freckle, will be placed under the patient's skin as reference points for the therapists to use during each daily treatment. Additionally, x-rays, CT scans, MRIs, PET/CT scans, or other state-of-the-art imaging technologies will be taken to assist in planning the course of treatment. These scans are different from the diagnostic scans the patient may have had previously because these will be performed in the treatment position.

After simulation is completed, the information is sent to special computerized treatment planning software, whereby the physicists and dosimetrists will work with the patient's radiation oncologist to formulate and design a personalized treatment plan for the patient. This complex planning process usually takes one to two weeks. Before the patient leaves, he or she will be given his or her treatment appointments and any special instructions.

First Day/Block Verification

Typically, the first treatment will take a little longer than the regular daily treatments and will be used to take x-rays to verify that what was planned during simulation is reproduced exactly. The patient will meet the radiation therapists who will be treating him or her through the course of his or her daily treatments, and a radiation oncologist may come to the treatment room to check the setup and make minor adjustments if necessary.

Daily Treatments

Once a week during the patient's treatment course, he or she will be seen by his or her radiation oncologist. These "on-treatment visits" usually fall on the same day each week, following the day's treatment. Patients should plan to be in the department longer on these days. During the course of treatment, patients may experience side effects from the radiation. Possible associated side effects are discussed in the Frequently Asked Questions section. Patients should bring any side effects, questions, or concerns to the attention of their nurse or radiation oncologist, so they can monitor them and provide specific instructions.

Follow Up

When treatment concludes, the radiation oncologist will continue to follow up closely with the patient. Depending on the physician and the treatment site, patients will be seen two weeks to one month following treatment, so their radiation oncologist can continue to monitor any side effects the patient may have experienced. For many months, patients may continue to experience subtle changes as a result of their treatment. Therefore, it is very important to continue with follow-up appointments. Future follow-up visits will be scheduled every three to six months, so the radiation oncologist can continue to monitor the patient's health. Routine scans may be ordered prior to an appointment. Additionally, the patient's radiation oncologist will continue to work with the patient's medical oncologist and/or primary care physician to ensure good health is maintained.

Hematology at Boston Medical Center


830 Harrison Avenue
Boston, MA 02118
Moakley Building, 3rd Floor


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