Clinics
Statistics
- 2,000 consults/year
- 7,000 follow-ups/year
- 30,000 procedures/year
- Top outpatient diagnoses:
- Prostate Cancer
- Breast Cancer
- Head and Neck Cancer
- Lung Cancer
- Brain Cancer
- Gynecological Cancer
Service by Treatment Site
- Prostate and Genital-Urinary Cancers
- Breast Cancer
- Head and Neck Cancer
- Lung and Esophageal Cancers
- Central Nervous System (CNS) Cancers
- Gynecological Cancer
- Eye Cancer
- Pediatric Cancer
- Skin Cancer
- Soft Tissue Sarcomas
- Colorectal and Hepatobiliary cancers
- Lymphoma
Services by Radiation Therapy Treatment Modality
Image Guided Radiation Therapy (IGRT)
Image-guided radiation therapy (IGRT) is an image-based technology that allows clinicians to locate a tumor target prior to a radiation therapy treatment. Multi-imaging modalities, including CT, MRI, PET, and US, are used for IGRT in our department. CT based IGRT technologies include MV CT with Tomotherapy, KV CT with CT-on-Rail (Primatom), and MV conebeam CT with Primus ( MVsion). Each of these technologies offers distinct feature to fit clinical needs. In addition, ultrasound system (BAT, B-mode Acquisition and Targeting) is also used. CT and BAT in treatment room can localize tumor targets rapidly and accurately at the time of a radiation therapy treatment. This dramatically reduces the need for large target margins which have traditionally been used to compensate for errors in localization. As a result, the amount of healthy tissue exposed to radiation can be reduced, minimizing the incidence of side effects. Image-guided brachytherapy is also used in the treatment of gynecological cancers.
- Tomotherapy
- MV Cone Beam CT (MVision)
- CT-On-Rail, Primatom/4DCT
Stereotactic Body Radiotherapy (SBRT)
Stereotactic Body Radiotherapy (SBRT) is an emerging image-guided radiation technique that is used to treat small and well-defined targets within the body. SBRT normally deliver very high doses of radiation precisely to tumor sites within the body with the purpose of improving local control and limiting side effects. SBRT may be used for small lung cancers or metastasis, small isolated liver tumors or bony tumors, and tumors in other sites that may not be appropriate for surgical resection or in patients who would not be candidates for surgery. SBRT is associated with few side effects because the treatment field is generally very small and treatment is precisely delivered. At the Froedtert Hospital and Medical College of Wisconsin, the delivery of SBRT involves in 4DCT based treatment planning, on-line CT guidance using either MV cone beam CT or kV CT-on-Rail, and respiratory gating.
- MV conebeam CT guided SBRT
Respiratory gating
In certain locations in the body, such as the lungs and abdomen, tumors can move as the patient breathes. In the past, this movement has confounded doctors ability to accurately deliver radiation therapy to these tumors. Respiratory gating is an emerging technology specifically introduced to solve this problem. During respiratory gating, radiation treatment is timed to an individual's breathing pattern, targeting the tumor only when it is in the best breathing phase. This approach decreases amount of normal tissue being irradiated, thus, reduces complications and side effects, while using higher doses and getting better outcomes. At the Medical college and Froedtert Hospital, we have been able to deliver respiratory gating since 2005.
- Gated delivery
Intensity Modulated Radiation Therapy (IMRT)
Intensity Modulated Radiation Therapy is changing the way radiation is delivered to treat head and neck cancers, prostate cancer, and many other cancers. Using a multi-leaf (MLC) collimator, IMRT focuses radiation directly on the tumor, delivering a higher, more effective radiation dose, while decreasing toxicity to adjacent organs. In prostate treatment, BAT (B-Mode Acquisition Targeting), a type of ultrasound used to locate the prostate gland daily, is used in conjunction with IMRT. This precise targeting is especially important in treating the prostate gland, which is very close to the bowel and bladder. Multiple image modalities (CT, MRI, PET) are used to guide IMRT in our department.
3-D Conformal Radiation Therapy (3DCRT)
This new radiotherapy method allows specialists to treat cancerous tumors with an unprecedented degree of accuracy. Based on a CT scan, the conformal radiation treatment planning computer constructs an electronic rendering of a patient's anatomy, allowing more precise treatment.
High Dose Rate (HDR) Brachytherapy
Brachytherapy is defined as the placement of radioactive sources directly into or close to a tumor. High radiation doses are delivered to the cancer cells with rapid fall-off in dose to normal tissues. Brachytherapy is often combined with external beam radiation therapy (EBRT), serving as a 'boost dose' to the area of suspected or gross tumor residual. Brachytherapy alone or in conjunction with other treatment modalities has become an important part of radiation treatment. HDR brachytherapy is used in our department to treat gynecological, breast, and prostate cancers.
HDR Brachytherapy gives new hope to a select group of women fighting breast cancer by delivering highly concentrated radiation "pellets" through a series of catheters directly to the site of a lumpectomy, significantly reducing treatment time. Mammosite® is a type of HDR Brachytherapy device available for a select group of women with early breast cancers. Mammosite® delivers radiation "pellets" through a single catheter with a balloon on the end, providing a radiation dose to tissues surrounding the tumor cavity following surgery to remove a breast tumor. To learn more about this and other treatment techniques for breast cancer, read Innovations and Technology Bring Breast Cancer Treatment Into the 21st Century.
High dose rate brachytherapy is also used to deliver conformal radiation with brachytherapy for patients with gynecological cancers on an out-patient basis. Computed tomography and/or magnetic resonance images are sometimes used to design these treatments.
Gamma Knife Therapy
Gamma Knife Therapy is a highly advanced technology that uses 201 focused beams of radiation to perform brain surgery.
Gamma Knife Therapy is a form of stereotactic radiosurgery which concentrates high doses of radiation on targeted masses of brain tissue to "vaporize" lesions. Sometimes referred to "as brain surgery without a knife" it offers treatment to patients with certain brain masses and arteriovenous malformations that have been considered inaccessible or unsuitable for traditional neurosurgery.
Conventional radiation therapy is delivered in many treatments over a period of time in low daily doses that accumulate to relatively high total doses. Conventional therapy is based on biological differences in the radiosensitivity of normal and malignant cells. All cells in the path of the radiation beam are exposed to the same amount of radiation, i.e., they receive the same radiation dose. Treatment 'protracted' or 'fractionated' over a period of time allows healthy tissue to rejuvenate after each session.
In contrast, with Gamma Knife Therapy, multiple beams of radiation merge on the intended mass from several directions simultaneously. Healthy tissue is therefore subject to minimal exposure, while the targeted mass receives a concentrated dose. The growth can the be treated in one session.
Seed Implants (Brachytherapy for Prostate Cancer)
Radioactive "seeds" are implanted in the prostate gland, where they fight cancerous tumors for several months. One of the advantages of using this technique for prostate cancer is that it limits the dose received by normal structures and patients are not required to return for daily radiation treatments.
Eye plaque brachytherapy
Eye plaques containing radioactive seeds are used in the treatment of choroidal melanomas.
Intravascular brachytherapy
Intravascular Brachytherapy is used as a treatment modality for reducing coronary restenosis after angioplasty procedures, especially for in stent restenosis.
Imaging Modalities
Computed Tomography (CT) Imaging
CT is an x-ray imaging procedure that uses a computer to combine multiple x-ray images to generate cross-sectional views, and when necessary, three-dimensional images of the structures of the body.
Positron Emission Tomography (PET)
Positron emission tomography (PET) generates images depicting the distribution of positron-emitting nuclides in patients. PET scanners use annihilation coincidence detection (ACD) instead of collimation to obtain projections of activity distribution in the subject. Relying on the applications of certain radiopharmaceuticals, PET can provide useful insight into the biological activities of patients.
Positron Emission Tomography (PET) / Computed Tomography (CT) Imaging
The CT-PET scanner combines positron emission tomography (PET) and high-speed, multi-slice computerized tomography (CT) imaging into an integrated system. PET captures images of miniscule changes in the body's metabolism caused by the growth of abnormal cells, while CT images simultaneously allow physicians to pinpoint the exact location, size, and shape of the diseased tissue or tumor.
Froedtert & Medical College is one of the first in the country to offer this new technology that allows physicians to detect tumors earlier by providing a more specific, comprehensive picture of disease.
Magnetic Resonance Spectroscopy Imaging (MRSI)
Magnetic Resonance Spectroscopy Imaging (MRSI) is a powerful tool that can provide useful biological/functional information associated with many different metabolites, allowing clinicians see changes in chemistry that indicate a change in cell activity - even when there is no apparent tumor.
Among the various techniques, proton spectroscopy is attractive in terms of sensitivity, spatial resolution, signal to noise, and acquisition time. Molecules that can be studied with MRSI include water, lipids, choline, citrate, lactate, and creatine, and amino acids. In recent years, MRSI has
grown in its application and availability for imaging various locations of the body. MRSI can provide a biological description of the chemical makeup of an imaged area in order to determine the presence of cancer. Furthermore, in situations where MRI is sensitive but not readily specific (post-biopsy hemorrhage, prostatitis, inflammation, tissue necrosis, interglandular dysplasia, prior local therapy, etc), MRSI allows us to better differentiate cancerous regions from normal tissue.
In our department, magnetic resonance spectroscopy is currently being used in a study to determine the MRS findings before, during, and after radiation for cervix cancer. Preparation of using MRSI to guide radiation therapy for prostate and brain tumors is underway.
functional Magnetic Resonance Imaging (fMRI)
fMRI is an imaging technique that is used to determine which parts of the brain correspond to particular activities or physical sensations (i.e., sound, sight, or the movement of an object). This 'mapping of the brain' is achieved by setting up an advanced MRI scanner in a special way so that the increased blood flow to the activated areas of the brain shows up on Functional MRI scans.