Image-Guided Radiation Therapy (IGRT)

Background Information:

What are the other Names for the Procedure?

• IGRT (Image Guided Radiation Therapy)

What is Image-Guided Radiation Therapy? (General Explanation)

• Image-Guided Radiation Therapy (IGRT) uses imaging techniques during a patient’s radiation therapy to improve accuracy and precision of the radiation therapy
• During this procedure, the physician is able to image the tumor before, during, or after the radiation therapy, as radiation delivering equipment is equipped with imaging technology such as CT, MRI, PET, ultrasound, or X-ray
• In this manner, the physician can compare images and provide precise and accurate radiation required, by changing the radiation beam or by altering the patient’s position
• IGRT is often used for tumors closer to critical organs or on organs prone to movements such as the prostate gland, liver, and lungs

What part of the Body does the Procedure involve?

The body part that is the focus of an Image-Guided Radiation Therapy depends on the location of the tumor.

Why is the Image-Guided Radiation Therapy Performed?

An Image-Guided Radiation Therapy is performed to precisely and accurately apply radiation therapy to a tumor.

What is the Equipment used? (Description of Equipment)

The equipment used for an Image-Guided Radiation Therapy is the following:

• Linear accelerator, which provides the radiation
• Imaging equipment such as an MRI, CT, ultrasound, or PET scan that is built in a linear accelerator

What are the Recent Advances in the Procedure?

There are no recent advances with respect to the Image-Guided Radiation Therapy procedure.

What is the Cost of performing the Image-Guided Radiation Therapy?

The cost of an Image-Guided Radiation Therapy procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.

When do you need a Second Opinion, prior to the Procedure?

• It is normal for a patient to feel uncomfortable and confused with a sudden inflow of information regarding an Image Guided Radiation Therapy procedure and what needs to be done
• If the patient needs further reassurance or a second opinion, a physician will almost always assist in recommending another physician
• Also, if the procedure involves multiple steps or has many alternatives, the patient may take a second opinion to understand and choose the best one. They can also choose to approach another physician independently
• If the radiation therapy is not as effective as expected, or if the tumor size is not reducing, then the patient is encouraged to contact their physician

What are some Helpful Resources?

http://www.radiologyinfo.org/en/info.cfm?pg=IGRT (accessed on June 7, 2014)

Prior to Image-Guided Radiation Therapy:

How does the Image-Guided Radiation Therapy work?

• The linear accelerator provides radiation beams during the Image-Guided Radiation Therapy procedure
• The CT, MRI, PET scans, or ultrasound is used for imaging purposes

How is the Image-Guided Radiation Therapy Performed?

• The patient is positioned on the treatment table
• Skin marks are used to provide radiation accurately to the target area
• Images are taken using the imaging equipment
• Images are reviewed and compared with images taken during simulation
• Adjustment to the patient’s position or radiation beams are made, as needed
• Once the patient is properly positioned, radiation therapy is delivered

Where is the Procedure Performed?

The Image-Guided Radiation Therapy procedure is performed as an outpatient procedure at a hospital.

Who Performs the Procedure?

A radiation therapist performs the IGRT procedure. The radiation therapist is supervised by a radiation oncologist.

How long will the Procedure take?

• The length of an Image-Guided Radiation Therapy depends on the tumor size, location, and many other related factors
• Imaging guidance generally adds 5 minutes to the radiation therapy

Who interprets the Result?

A radiation oncologist interprets the results of the IGRT procedure.

What Preparations are needed, prior to the Procedure?

The following preparations may be needed prior to the Image-Guided Radiation Therapy procedure:

• The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient, including information related to the medications that are currently being taken
• Do inform the medical professional if you have a history of any medical conditions, such as a heart disease, asthma, diabetes, or kidney disease
• Do inform the medical professional about any allergies, especially related to barium or iodinated contrast material, which may be used in the procedure
• It is advisable to wear comfortable and loose clothes. Avoid wearing any metal objects or jewelry, as it may interfere with the X-ray
• Women should notify the physician, if they are pregnant or breastfeeding their child, as many such procedures may not be performed on pregnant women
• Depending on the procedure adopted, the patient may be asked for certain bowel or bladder preparations before the preparation sessions
• Ultrasound is not recommended if the patient has had a barium enema or GI test in the past two days
• The patient may be asked to avoid eating or drinking several hours before the test
• About 1 week prior to the IGRT procedure, radiodense markers are placed near or in the tumor to identify the area for the treatment. The patient’s skin is marked to help in the location of the radiation equipment
• In case MRI is used during the procedure, patients with pacemakers should notify their physician about their condition

What is the Consent Process before the Procedure?

A physician will request your consent for an Image-Guided Radiation Therapy procedure using an Informed Consent Form.

Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.

You must sign the forms only after you are totally satisfied with the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.

What are the Benefits versus Risks, for this Procedure?

Following are the benefits of the Image-Guided Radiation Therapy procedure: 

• It helps destroy the tumor cells directly
• It helps minimize the side effects of radiation therapy to neighboring healthy tissues, as IGRT is a precise and accurate technique

Following are the risks of the Image Guided Radiation Therapy procedure:

• Possibility of a secondary cancer (in some rare cases)
• Rarely, lung, brain, spinal cord, and bone joint changes may take place
• Infertility

What are the Limitations of Image-Guided Radiation Therapy?

Following are the limitations of the Image-Guided Radiation Therapy procedure:

• Depending on the image guidance technique used, the resolution of the tumor image may vary
• If the location of the tumor is near a bone, then ultrasound guidance may be difficult

What are some Questions for your Physician?

Some of the basic questions that you might ask your healthcare provider or physician are as follows:

• What is an Image-Guided Radiation Therapy (IGRT) procedure?
• Why is this procedure necessary? How will it help?
• How soon should I get it done? Is it an emergency?
• Who are the medical personnel involved in this procedure?
• Where is the procedure performed?
• What are the risks while performing the procedure?
• What are the complications that might take place during recovery?
• What are the possible side effects from the procedure? How can I minimize these side effects?
• How long will it take to recover? When can I resume normal work?
• How many such procedures have you (the physician) performed?
• Are there any lifestyle restrictions or modifications required after the procedure is performed?
• Are there any follow-up tests or periodic visits to the healthcare facility required, after the procedure?
• Is there any medication that needs to be taken for life after the procedure?
• What are the costs involved?

During the Image-Guided Radiation Therapy:

What is to be expected during the Image-Guided Radiation Therapy?

• The linear accelerator produces an ozone gas, which has a pungent smell
• The IGRT procedure is painless and noninvasive

What kind of Anesthesia is given, during the Procedure?

No anesthesia is administered during the Image-Guided Radiation Therapy procedure.

How much Blood will you lose, during the Procedure?

There is no blood loss involved during the Image-Guided Radiation Therapy procedure.

What are the possible Risks and Complication during the Image-Guided Radiation Therapy?

The following risks are possible during the Image-Guided Radiation Therapy procedure:

• Risk of a secondary cancer (in the future)
• Changes in the lung, brain, spinal cord, and bone joints, which may occur in rare cases
• Infertility
• The procedure may not be advised for pregnant women and children

What Post-Operative Care is needed at the Healthcare Facility after the Image-Guided Radiation Therapy?

There is no significant post-operative care necessary at the healthcare facility, after an Image-Guided Radiation Therapy procedure.

After the Image-Guided Radiation Therapy:

What is to be expected after the Image-Guided Radiation Therapy?

• The patient may experience skin blistering, redness, or swelling in the areas exposed to radiation therapy
• Hair loss, fatigue, nausea, vomiting, diarrhea, mouth-related signs and symptoms, urinary changes, and headaches are commonly observed as early side effects of the Image Guided Radiation Therapy
• Lymphedema (swollen lymph nodes) and changes in the mouth may be noted, after the treatment

When do you need to call your Physician?

The patient may need to contact the physician if the side effects of the Image-Guided Radiation Therapy procedure worsen.

What Post-Operative Care is needed at Home after the Image-Guided Radiation Therapy?

• The patient may need to take anti-emetic medications that may be prescribed after the IGRT procedure
• No specific post-operative care is needed at home, though the radiation therapy side effects may require attention

How long does it normally take to fully recover, from the Procedure?

The length of recovery after an Image-Guided Radiation Therapy procedure depends upon the amount of radiation delivered and the location of the tumor.

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

No tissue is extracted from the patient during an Image-Guided Radiation Therapy procedure.

When should you expect results from the pathologist regarding tissue taken out, during the Procedure?

Since no tissue is removed during the procedure, a pathologist does not get involved in the care of the patient.

Who will you receive a Bill from, after the Image-Guided Radiation Therapy?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers.

Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

• The hospital where the procedure was performed
• Radiation oncologist’s office

The patient is advised to inquire and confirm the type of billing, before the Image-Guided Radiation Therapy (IGRT) procedure is performed.