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Guide to Radiation Therapy at UMHS

Parking

When you are being seen in the Radiation Oncology department, you should park in our parking lot, located off E. Medical Center Drive between the Cancer Center and the Emergency Room entrances.
Obtain a Radiation Oncology hang tag from the reception desk. This tag must be displayed in your vehicle at all times while in the Radiation Oncology parking lot. If this tag is in place, parking for Radiation Oncology patients is free.

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Consultation

During the consultation, your Radiation Oncologist will examine you and reconfirm your diagnosis with the use of your X-rays, medical images and pathology. At this time, your Radiation Oncologist and Nurse will discuss your treatment plan.

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Scheduling

Once it is determined you will undergo a course of radiation therapy, your simulation, or CT simulation and initial treatment time, will be scheduled. Your daily treatment schedule will be made by the Therapists who treat you. They will try to schedule a time close to your preferred time. If your Therapists cannot accommodate you at first, they will change your schedule as soon as your preferred time becomes available.

It is important for you to check in at the check-in station for all your scheduled appointments. If you cannot make an appointment, please notify the department staff at 734-936-4300 or 800-882-7150.

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CT Simulation

Your Radiation Oncologist may request a CT (CAT scan) Simulation. It is important to note that not all patients require a treatment planning CT. A treatment planning CT is not the same as a diagnostic CT.

An immobilization device may be made and used for your CT Simulation. Either before or during the simulation you may be given an injection of a special dye that helps us to see certain organs. Your nurse or treatment team will inform you of any special instructions before your CT Simulation. All of the information from your CT will be put into our treatment planning computer system and will be used to determine the type of treatment field, energy and angle of the beam for your radiation treatments.

A treatment planning CT Simulation may take 30 to 60 minutes and is performed in the Radiation Oncology department.

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Simulation

Simulation is an imitation of your radiation treatment without the actual radiation beam and it is the first step of your treatment planning process.

The simulator is an X-ray machine modeled after our treatment units. It uses fluoroscopic X-rays to visualize your internal anatomy and correctly position your treatment fields. It also has the ability to take X-rays to verify your treatment area.

It may be necessary for you to change into a gown for this procedure.

Once your immobilization device has been made, the simulator Therapist will position you using fluoroscopy (X-ray). Next, under the direction of your Radiation Oncology, X-ray films will be taken of the area. These films are checked by your Radiation Oncologist, and marks will be placed on your skin and on the immobilization devices so that your position can be duplicated for each treatment session. The marks on your skin may be placed with a felt tip marker and/or tattoo ink dot. If a mask was made for you, all of the marks will be placed on the mask, not on your skin. In the simulator and the treatment room, laser beams are utilized to help confirm your precise alignment. These laser beams are not harmful to you and are just for positioning purposes.

Occasionally, a liquid that can be visualized on an X-ray (called a "contrast medium") is used to assist your Radiation Oncologist in visualizing the target region or normal tissue during your simulation. You will receive instructions before the contrast medium is given.

Before the Therapist takes you off the table, a picture will be taken of you in your treatment position. Also, pictures will be taken of your face and of the marks on your skin. These pictures are for documentation and will be put in your radiation treatment chart only.

Your simulation may take 45 to 120 minutes depending upon the area being treated and is performed in the Radiation Oncology department. A simulation may not be performed instead, a CT Simulation may be used.

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Immobilization Devices

During your simulation, your Radiation Oncologist will decide if an immobilization device is needed for your treatment. Several types of immobilization devices are used, including:

Plastic Mesh Devices – Made from a hard plastic that becomes very flexible in warm water. When it is wet, it conforms to the contour of the treated area. It will dry very quickly.

Foam Cradles (for the chest, abdomen and pelvis areas) – Made with a liquid styrofoam that expands and hardens. As it expands, it forms to the shape of your body. While expanding the foam gets warm and as it cools it hardens.

Breast Arm Board (for the breast and chestwall areas) – Made of metal and plastic. This device allows your arm to be lifted and raised away from your body. The arm board is pre-made and attaches to the treatment table.

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Beginning Your Treatment

Please check in at the front desk before your treatment. If you changed into a gown for your simulation, a gown will be required for your daily treatment. Lockers are available in the dressing rooms for your clothes, but locks are not provided. You may bring a padlock with you.

On your first day, the Therapists on the treatment unit will be taking more X-ray films or portal images. These are very important and will be used for comparison to the films taken during your simulation. After the films or images match perfectly, you will receive your first radiation treatment. During your radiation treatment, you will not see or feel anything. Although you are in the treatment room alone, the Therapists are monitoring you through the use of an intercom and closed-circuit television system.

Our department has four state-of-the-art treatment units called linear accelerators (LINACs). These units have the capability of performing computer-controlled radiation therapy treatments. Your Radiation Oncologist will choose the most suitable unit for your treatment. The linear accelerator is a device that utilizes electromagnetic waves to accelerate charged particles through a specially designed tube that generates a powerful radiation beam.

On occasion, we may have treatment unit delays or down time. If this happens, we will try to accommodate you on one of our other units. This may cause delays in our schedules. We will try to notify you of these delays. Please make sure we have a phone number where you can be reached.

Our goal is to try to accommodate everyone. This may not always be possible and we may have to cancel an appointment.

Unless a patient needs assistance, it is preferred that family members wait in the front lobby. For other patients' privacy, patients are asked to remain in the waiting rooms and not in the halls outside the treatment rooms.

Your first day of treatment may take 30 to 90 minutes. After that, your daily treatment may only take 15 to 30 minutes. You will see your Radiation Oncologist once a week unless you have other problems that require their attention.

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Completion of Treatment

Close to the end of your treatment course, your Nurse and Radiation Oncologist will discuss your follow-up care. Please pick up your follow-up schedule from the clinic desk.

Also upon your completion of treatment, your Referring Physician will be sent a summary letter outlining your course of treatment.

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Blood Draw

Most patients will need to have their blood drawn at least once during their course of treatment. A complete blood count (CBC) is drawn which measures white blood cells that fight infection, red blood cells that carry oxygen and platelets that help clot blood. The frequency of blood draws is dependent upon the area of the body being treated. Whenever possible, your blood will be drawn in the Radiation Oncology department. Ask your nurse for more information.

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Housing in Ann Arbor

For patients and family members who travel long distances to University Hospital, there are overnight accommodations available.

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Billing and Financial Counseling

The Radiation Oncology Billing Office submits claims for services to insurance companies, government programs (i.e., Medicare and Medicaid) or any other appropriate payer indicated by you. Billing Office personnel will verify the completeness of necessary billing forms and supply all the necessary information for the payers to process and pay the claim. Please bring with you any referrals or authorizations your insurance company requires in order to make payment for services.

During the first week of your radiation treatment, a Financial Counselor may meet with you. The Financial Counselor will discuss your insurance benefits relating to radiation therapy and answer any questions you may have relating to balances for which you are responsible. Also, at that time you will receive a general explanation of the billing process at the University of Michigan Medical Center. A Financial Counselor is available in the clinic one day each week. Please ask for details.

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Pediatrics and Radiation Oncology

Children of all ages are treated here at the University of Michigan Health System. Some children, particularly infants, may need to be sedated or anesthetized for treatments and treatment planning appointments. Whenever possible, we will work with your child through play therapy to obtain her/his cooperation without the use of medications. We also encourage children to bring security objects such as stuffed animals, blankets or cassette tapes with their favorite music, stories or a parent's voice to help ease their fear.

Also to help ease your child's fear of the radiation treatment, we would recommend a tour that can be scheduled before they begin their treatment. In addition, it may be possible for your child to meet the Therapists who will be treating them.

While your child is having his or her radiation treatment, it would be appreciated if parents would wait in the waiting areas and not the hall. This is requested for the other patients' privacy.

If there is ever a concern that needs to be addressed, the Manager of Operations will be happy to discuss it with you.

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Treatment Protocols

In addition to providing state-of-the-art radiation therapy, the Radiation Oncology Department is involved in research. Occasionally, we may ask patients to participate in treatment protocols. These are specific treatment plans designed with the intention of improving therapy or decreasing side effects. When the protocol is active, we will not know whether the potential improvement exists. In fact, there may be some risks associated with protocols. Your Radiation Oncologist will explain both potential risks and benefits in detail with you and obtain your written permission before starting you on a research protocol.

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Brachytherapy

Brachytherapy is a specialized form of treatment that is used to treat only specific areas. Radioactive sources are placed or inserted in your body. The most common materials used are Cesium 137, Iridium 192 or Iodine 125. This treatment can be used to give the area of disease a more concentrated dose or may be the only form of treatment given. This type of therapy allows radioactive sources to be placed directly into a tumor, which means a high dose goes to the tumor and a low dose goes to normal tissue.

This treatment may require a hospital stay. If you are to have this type of treatment, your Radiation Oncologist will thoroughly explain the details to you.

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Quality Assurance

Great measures are taken to assure the accuracy of your treatment. These measures include chart rounds, port films and unit checks.

A chart round is a weekly meeting where all the charts of patients currently under treatment are reviewed by Radiation Therapy personnel. Calculations, documentation, doses, films and database information are all rechecked to ensure that all parts of your treatment are accurate and up to date. In addition, this meeting is a time to communicate your progress and any changes in your treatment plan. Your Radiation Oncologist, Resident, Nurse and Therapists attend this meeting.

Port films are taken approximately every five treatments to continue to verify your treatment. Your port films are always checked by your Radiation Oncologist, Resident and Therapists.

Your treatment unit has routine daily checks as well as weekly and monthly checks. Measurements are also verified by the Medical Physicist.

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