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Steps that occure before therapy
Parking
Consultation
Scheduling
Steps involved in planning your therapy
CT
Simulation
Simulation
Immobilization
Devices
Beginning
Your Treatment
Completion
of Treatment
Blood
Draw
Other things you may want to know
Housing
in Ann Arbor
Billing
and Financial Counseling
Pediatrics
and Radiation Oncology
Treatment
Protocols
Brachytherapy
Quality
Assurance
Glossary
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.
All patients (except those with state-issued gold
parking permits) must use metered parking. Note your
space number and pay at the machine located at the
building entrance; please bring coins as the machine
does not accept dollar bills. The cost is 60 cents/hour.
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.
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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, x-ray films will be taken of the area
under the direction of your Radiation Oncologist.
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 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: a plastic mesh mask,
a foam cradle, and a breast arm board.
Plastic Mesh Devices are 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)
are 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)
is 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. 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 not to cancel appointments, but 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 family members
wait in the front lobby. For other patient's 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 those patients and family members that travel
longer distances to receive treatment at University
Hospital, there are housing
options available. The Med-Inn is a hotel located
within the University of Michigan Medical Center.
For reservations (required) and information regarding
Med-Inn, call (734) 936-0100. Some local hotels offer
our patients and families special rates on a daily
or weekly basis. For more information regarding these
hotels, call our Social Worker at (734) 936-8700.
Wilmot House is a two story, four bedroom
house located within one-half mile from
the hospital and is available to adult
(18 or older) outpatients of the Department
of Radiation Oncology. You must live
50 miles or more one way from the University
Hospital and not be wheelchair dependent
or need more assistance than your companion
can provide. Wilmot House has community
style living.
Each guest has a room that contains two twin beds.
There is one bathroom for every two guest rooms.
The fully furnished common living areas include a
large living room with a TV and stereo, a kitchen
(including dishes and cooking utensils), laundry
facilities, and parking. No smoking or alcoholic
beverages are allowed in the House. If you do not
have your own transportation to your radiation appointments
or need more information on tours, rates and reservations,
call the Social Worker at (734) 936-8700 or stop
by the Social Worker's office while you are in the
clinic.
The Ronald McDonald House is a home
away from home for ill children and their
families. There is usually a waiting
list and patients are placed on the list
based on several criteria, including
severity of the injury/illness, financial
need and inpatient or outpatient care
being received. There are 29 bedrooms
and 15 bathrooms with community style
living. There are staples and some food
provided in the kitchen. Each family
unit is assigned a chore to help keep
the house clean. There are age appropriate
play areas, a pool table, electronic
games, TVs and a stereo in the community
living areas of the house. For more information
or reservations, call the Ronald McDonald
House at (734) 994-4442.
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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. The 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 which 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 Medical Center. 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 the
use of 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
that will be treating them.
While your child is having their 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 more 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 high dose to the tumor and
low dose 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.
"Chart rounds" 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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Glossary
Biotherapy
treatment by stimulation of the body's immune defense
system
CAT Scan
(Computerized Axial Tomography) form of X-ray that
obtains "3-D" pictures of the area of interest within
the body
Chart Rounds
weekly meeting where reviews of all patient charts
under treatment are conducted by Radiation Therapy
personnel
Chemotherapy
treatment with anti cancer drugs
Contrast Medium
a liquid that assists the Radiation Oncologist in
visualizing the target region or normal tissue during
your simulation
Diagnostic
a procedure to investigate or reveal an abnormality
within the body
Fields
direction in which the area is being treated
Immobilization Device
device to assist you in maintaining the same position
for each treatment
Linear Accelerator
machine that uses high power X-Rays to give the treatment
dose
Oncology
the study of tumors
Palliate
to relieve symptoms
Pathology
the study of diseases
Port Films
X-Rays that verify the treatment area
Post-operatively
after surgery
Pre-operatively
before surgery
Protocol
treatment plans designed with the intention of improving
therapy or decreasing side effects
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