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.
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.
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.
Patients with blood disorders receive consultation and treatment for a broad range of benign conditions, such as hemoglobinopathies (sickle cell anemia and thalassemia), hemochromatosis, bleeding and thrombotic disorders (von Willebrand's disease and hemophilia), hypercoagulable states, myeloproliferative disorders, myelodysplasia and anemia, and malignancies such as leukemia, lymphoma and myeloma.
Treatments & Services
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 (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.
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.
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.
The Department of Radiation Oncology at Boston Medical Center/Boston University Chobanian & Avedisian School of Medicine values diversity in our patient population, faculty, and staff, including with regard to race, religion, ethnicity, country of origin, cultural heritage, gender, sexual orientation, and gender identity and expression. We are dedicated to providing accessible and exceptional healthcare to everyone. We believe that a diverse faculty and staff help us deliver culturally sensitive and exceptional care to all members of our uniquely diverse patient population. The diversity of our patients, healthcare team, and faculty helps make the Department of Radiation Oncology an exciting place to practice, teach, investigate, advocate, and innovate. The Department is committed to recruiting, supporting, and advancing a diverse faculty and staff.
Siyoung Jang, PhD
Chief of Physics
Harry Bohrs, BSc
Senior Dosimetrist, Department of Radiation Oncology
Soyoung Lee, PhD
Dosimetrist, Department of Radiation Oncology
Xin Zhang, PhD
Physicist, Department of Radiation Oncology
Radiation Therapy Team
Kevin O’Leary, Chief Therapist
Frequently Asked Questions
The Radiation Oncology Department has considerable experience in treating all types of cancers and benign (noncancerous) tumors. Individual staff members concentrate on specific types of cancer, so patients can benefit from their specialized knowledge. BMC radiation oncologists are also actively involved in researching new and promising cancer treatments through clinical trials.
Promising new techniques in the diagnosis, treatment, and care of patients with cancer are tested in research studies called clinical trials. Many patients who participate in clinical trials derive comfort from knowing that the knowledge gained from these trials will make an important contribution to medical science and may help other people with cancer.
BMC is a study site for various cooperative groups, including:
- CTSU (Cancer Trials Support Unit)
- NRG Oncology
Visit the Boston University Chobanian & Avedisian School of Medicine’s website for a list of currently active clinical trials.
Residency and Fellowship Information
Medical Student Rotations
As a leader in Radiation Oncology education on the medical student level, Boston Medical Center (BMC) Radiation Oncology is a popular site for clinical rotations during the 3rd and 4th year of study at Boston University Chobanian & Avedisian School of Medicine. We offer two electives in the Cancer Education and Research Program: Clinical Radiation Oncology and Clinical Cancer Research. First-year and second-year medical students may also rotate through our department in the Introduction to Clinical Medicine course. Visiting medical students can schedule rotations here through the Boston University Chobanian & Avedisian School of Medicine Registrar’s Office.
Students are given the opportunity to perfect their ability to take a history and perform thorough physical examinations. They also learn about the natural history of select cancers. Our attendings and residents provide didactic guidance throughout this experience. Students are encouraged to learn how we design radiation treatments and are able to spend time in the radiation physics section working on radiation plans. Students may also spend time at the treatment machines to observe the delivery of radiation therapy. Students are afforded the opportunity to give a presentation to the department on a topic of their choice related to radiation therapy at the end the rotation.
Medical Student Research
BMC has various exciting research opportunities at both BMC and MGH for students with a strong interest in oncology. Students can take on retrospective analyses of clinical data or spend time in basic research related to the repair of DNA damage (which focuses on genes such as p53, BRCA1, BRCA2, Chk2, ATR, and Fanconi Anemia). BMC also offers exciting opportunities for medical students to participate in physics-based or education-based projects.
Students have been very successful in their research endeavors, including presenting their work at various national meetings such as ASTRO, RSNA and ASCO. Additionally, they have won numerous research awards. Examples include the RSNA Trainee Research Award, the Best Student Abstract at the Boston University Chobanian & Avedisian School of Medicine Medical Education Day, Medical Student Summer Research Fellowships, the Aid for Cancer Research Fellowship, Second Place at the Massachusetts Medical Society Annual Research Symposium for Students, Residents and Fellows, and the Anne & David Mishel Cancer Research Award.
Harvard Radiation Oncology Program
Boston Medical Center is one of the teaching institutions integral to the Harvard Radiation Oncology Program (HROP), along with MGH, BWH, BIDMC, DFCI, & Children’s Hospital. All of the HROP residents rotate through our department at least once before graduation for three-month long clinical rotations. Residents appreciate the diverse patient population and the often unusual spectrum of tumors and clinical issues they encounter at BMC. While here, the residents make presentations for at least one tumor board and give at least one Morbidity & Mortality (M&M) conference. Residents can also participate in BMC-driven research projects during their rotations.