OPENProcess of Carbon Ion Radiotherapy
Overall process
The process from initial consultation to treatment and discharge is described below.
Carbon ion radiotherapy involves 4 steps: new patient consultation, treatment preliminaries, treatment, and post-treatment process (discharge).
- New patient consultation: assessment of your indication for treatment, detailed explanation about treatment, and your consent to receive treatment
- Treatment preliminaries (inpatient or outpatient)
- Treatment (inpatient or outpatient)
- Post-treatment process (discharge *if admitted): follow-up
QST Hospital does not have a language assistance service. If you have difficulty communicating in Japanese, therefore, you must be attended by a professional medical interpreter who is proficient in both your language and Japanese. To secure your safety and provide you with the optimal treatment, precise verbal communication is essential.
New patient consultation
For your initial consultation, please make an appointment with this hospital through your primary physician or medical coordinator. On the day of appointment, please come to the reception desk of this hospital in person, with medical information documents including a referral letter, the results of diagnostic imaging procedures such as computed tomography (CT) and magnetic resonance imaging (MRI), and a histology report. A photo from your shoulders up will be taken of you for identification.
The nurse at the outpatient reception desk will first ask you about your physical condition and any illnesses to date.
Appointment for Initial Consultation/Second Opinion
Consultation by physician
The physician will assess whether carbon ion radiotherapy is indicated for your condition. Because the patient's general condition and the status of the cancer lesion suitable for treatment vary according to the site and type of the disease, the physician will closely review your medical information documents that you bring, ask you about your medical history, and perform necessary physical examinations. If more information is required to determine eligibility of your condition for the treatment, the physician may perform a diagnostic imaging procedure such as CT, MRI or positron emission tomography (PET), or ask your primary physician for permission to use the histology specimen to confirm the pathological diagnosis.
Informed consent
If your condition is confirmed to be eligible for the treatment, you will receive a detailed explanation of carbon ion radiotherapy.
The explanation will cover the types of therapeutic benefits that can be expected and side effects that may occur based on previous experience. If you consent to receive carbon ion radiotherapy, you (and your family member) will be asked to sign a consent form.
Treatment preliminaries
Treatment preliminaries will commence 1 to 2 weeks before the treatment starts. (Some diseases can be treated during outpatient visits, while others require hospitalization.)
You will be involved in the 2 steps of the treatment preliminaries, making “immobilization devices” and acquiring “simulation CT”.
If you have an intraocular tumor, you can also participate in a treatment rehearsal.
Before starting treatment, the hospital cancer board reviews matters such as the appropriateness of performing carbon ion radiotherapy, the suitability of the treatment and treatment plan, and whether the patients adequately understand the details of the treatment and its side effects.
Manufacturing immobilization devices
During the treatment, the patient needs to maintain the most comfortable posture so that the patient can keep the posture during treatment procedure for the carbon ion beam to be irradiated accurately.
Immobilization devices includes mask, molds, and shells. They are made by thermosoftening plastic, polystyrene foam, or material which composite casts for bone fracture. Thermosoftening plastic becomes soft and moldable at high temperature ( approximately 50℃ or 120 ℉), and hard at room air temperature.
Necessary immobilization devices vary depending on treatment location and treatment design. If the ideal treatment plan requires irradiation both in a supine and a prone position, double set of fixation devises are made.
To maintain the posture, immobilization devices will be created to suit the individual patient. The manufacturing room is located in the basement of the New Particle Therapy Research Facility, where the carbon ion radiotherapy will be performed.
Inpatients will be led to the location by hospital ward staff. For outpatients, the location will be explained beforehand during the consultation.
The Fixation devices will be prepared after a physician or radiology technologist briefly explains about the devices. The preparation will take approximately 20 minutes to 1 hour. (Some patients who will receive irradiation to the head or neck may need dental treatment before this date, and some patients who will receive irradiation to the liver or lungs may need insertion of a marker. Please ask the physician in charge for further information.)
Process to make immobilization devices
- Two (2) photographs for identification are taken
- Change of clothing
- Positioning
- Patients are typically held stationary while lying face up or face down, but they may be asked to lie on their side.
- A mat is prepared to support the body from underneath.
- A plastic sheet is prepared to hold the patient's body down from above.
- One (1) photograph is taken to confirm the position of the brace.
Important points to keep in mind during brace preparation
It is important that you lie in a comfortable posture. You may keep the position up to half an hour.
If you are comfortable, unnecessary movement will be minimized, allowing more accurate irradiation.
The immobilization devices provide the support needed for you to receive accurate treatment in the most comfortable posture.
CT simulation
Simulation CT images are acquired to prepare the treatment plan. The CT procedure will also be performed in the basement of the New Particle Therapy Research Facility.
CT imaging is performed with the patient lying in the immobilization devices that was prepared beforehand. It is performed from angles determined by the physician in charge (in some cases, the bed may be tilted at an angle up to 20 degrees).
When imaging an organ that moves with breathing, the scan will be performed using a method called "respiratory gating." With this method, the patient's respiratory status is observed on a monitor, and imaging is performed only in the same, stable phase of respiration. During the actual treatment, the carbon ion beam is emitted only in the same phase of respiration.
The simulation CT acquisition takes approximately 30 minutes to 1 hour.
Based on the CT images, the physician in charge will define the target locations for carbon ion radiotherapy on the computer, and treatment plan will be prepared by dosimetrists who specialize in treatment planning. After confirming dose distribution, treatment plan will be checked by irradiating to detector sensor, whether the treatment can be performed as simulated. Then, treatment is ready. It takes about 10 days from simulation CT acquisition to actual treatment.
Important points regarding the CT simulation
You will have a chance to adjust the fit of the immobilization devices to your body. If there are any problems, please notify the staff.
When respiratory gating is used, the procedure usually proceeds more smoothly if you breathe naturally without focusing on your breathing. (If conscious breathing is preferred, you will be asked to do so.)
Treatment rehearsal
Treatment rehearsals are currently required only for patients with intraocular tumor.
During the rehearsal, you will be asked to practice staring at a light source (LED) that serves as a landmark, just as during the actual treatment. The rehearsal will take place the day before the start of treatment in the same room where the treatment will be performed. You will wear the brace during the rehearsal.
Treatment
Carbon ion radiotherapy is performed in 3 rooms, Rooms E, F, and G. Rooms E and F enable radiotherapy in 2 beam directions, vertical and horizontal, and Room G is equipped with a rotating gantry that allows irradiation from any direction. The beam direction used in a single irradiation varies for each patient, and it may be performed in different directions for the same patient on different days. During each daily treatment, 5 to 20 minutes will be spent on precise positioning.
The time of actual irradiation varies depending on the location and size of the lesion and whether respiratory gating is required. Short treatments take less than 1 minute, and long treatments last 10 minutes or longer. There is no sensation of stimuli such as pain or heat as a result of the irradiation. The number of irradiations is determined according to the treatment plan for each patient. (Depending on the site irradiated, pretreatment may be performed before irradiation. Please follow the instructions of the ward nursing staff.)
Post-treatment process (discharge)
If you have received the treatment as a hospitalized patient, you will be discharged from the hospital the day after or several weeks after treatment completion. Before discharge (or at treatment completion in the case of outpatient treatment), you will receive an explanation of follow-up schedule from the physician in charge.
In many cases, careful post-treatment follow-up will be performed at 2 locations: this hospital and the hospital which referred you to our hospital.
Follow-up is performed to confirm the effectiveness of the treatment and determine whether side effects occur. Examinations for follow-up may be performed both as an in-patient or an out-patient. Because the types of tests and the intervals between them vary depending on the disease, these aspects will be explained individually at the completion of treatment.
Depending on the disease, we will also assess the quality of life (QOL) measures established in the treatment plan.