What is Image-guided radiation therapy (IGRT)?

Image-guided radiation therapy (IGRT) is an advanced form of radiation therapy that utilizes imaging techniques during treatment to precisely target tumors. Think of it as GPS for radiation – it ensures the radiation beams hit their intended target with pinpoint accuracy, even if the tumor moves or changes shape during the course of treatment. This is particularly crucial because tumors aren't static; they can shift due to breathing, digestion, or even changes in bladder or bowel fullness. IGRT overcomes these challenges by allowing doctors to visualize the tumor immediately before or during radiation delivery and make real-time adjustments.

In essence, IGRT is a refinement of traditional radiation therapy, maximizing its effectiveness while minimizing harm to healthy tissues. It's a significant advancement in cancer treatment, offering the potential for improved outcomes and reduced side effects.

Why is Image-guided radiation therapy (IGRT) Performed?

IGRT is performed to enhance the precision and effectiveness of radiation therapy, leading to better outcomes for patients. Here's a breakdown of the key reasons why doctors recommend IGRT:

• Precise Targeting: The primary goal of IGRT is to improve the accuracy of radiation delivery. By using imaging to visualize the tumor in real-time, doctors can ensure that the radiation beams are precisely targeted, even if the tumor moves or changes shape. This is especially important for tumors located in areas prone to movement, such as the lungs, liver, or prostate.

• Improved Tumor Control: By delivering radiation more precisely, IGRT allows doctors to administer higher doses of radiation to the tumor while sparing surrounding healthy tissues. This increased dose intensity can lead to better tumor control and a higher chance of eradicating the cancer cells.

• Treating Moving Tumors: Tumors located in the chest or abdomen are constantly moving due to breathing and other bodily functions. IGRT is particularly beneficial for these types of tumors, as it allows doctors to track the tumor's movement and adjust the radiation beams accordingly. This ensures that the tumor receives the full dose of radiation, even as it moves.

• Protecting Critical Organs: Many tumors are located near critical organs or tissues, such as the heart, lungs, spinal cord, or kidneys. IGRT helps to minimize the amount of radiation exposure to these vital structures, reducing the risk of side effects and long-term complications.

• Verifying Positioning: IGRT confirms that the patient is in the correct position for treatment each day. This is crucial for ensuring that the radiation is delivered accurately and consistently.

• Adaptation to Changes: Tumors can shrink or change shape during the course of radiation therapy. IGRT allows doctors to monitor these changes and adjust the treatment plan accordingly.

In summary, IGRT is performed to:

• Increase the accuracy of radiation delivery.
• Improve tumor control.
• Treat moving tumors effectively.
• Protect critical organs.
• Verify patient positioning.
• Adapt to changes in the tumor.

Preparation for Image-guided radiation therapy (IGRT)

Preparing for IGRT involves several steps to ensure the treatment is planned and delivered accurately. The preparation process is crucial for maximizing the benefits of IGRT and minimizing potential side effects.

• Consultation and Examination: Your doctor will conduct a thorough consultation and physical examination to assess your overall health and determine if IGRT is the right treatment option for you. This will involve reviewing your medical history, discussing your symptoms, and performing any necessary diagnostic tests.

• Simulation Session: A simulation session is a crucial part of the IGRT preparation process. During this session, you will be positioned on a treatment table, and imaging scans (usually CT scans) will be taken to create a detailed 3D map of your tumor and surrounding tissues. This map will be used to plan the radiation treatment.

  • The simulation session is painless, but it may take some time, as it's essential to find the most comfortable and reproducible position for you to maintain during each treatment session.
  • During the simulation, the radiation therapists will mark your skin with small tattoos or semi-permanent marks. These marks will be used to align you correctly for each treatment session.
  • It's important to avoid washing off these marks until the completion of your radiation therapy.

• Imaging Procedures: In addition to CT scans, other imaging procedures, such as MRI or PET scans, may be used to further define the size, shape, and location of your tumor. These images help the radiation oncologist create a highly accurate treatment plan.

• Positioning Device: A special positioning device, such as a mold or cast, may be created to help you maintain the same exact position during each treatment session. This device will ensure that the radiation beams are delivered accurately and consistently.

• Fiducial Markers (If Necessary): In some cases, small markers (made of gold, plastic, or other material) may be placed in or near the tumor to help locate the cancer. These markers, called fiducial markers, serve as reference points for the radiation beams, ensuring precise targeting. The placement of fiducial markers is a minimally invasive procedure.

• Bowel and Bladder Preparation: For tumors in the abdomen or pelvis, you may be asked to follow specific instructions regarding bowel and bladder preparation. This may involve drinking a certain amount of water before each treatment session or emptying your bladder beforehand. These instructions help to ensure that the tumor is in the same position each day.

• Dietary Instructions: Depending on the location of your tumor, you may receive specific dietary instructions to follow during the course of radiation therapy. These instructions may help to minimize side effects, such as nausea, diarrhea, or constipation.

• Medications: Your doctor may prescribe medications to help manage any potential side effects of radiation therapy. These medications may include anti-nausea drugs, pain relievers, or anti-diarrheal medications.

• Pre-Treatment Checklist: Before starting IGRT, your doctor will review a pre-treatment checklist with you to ensure that you are fully prepared for the treatment process. This checklist will cover all aspects of the treatment, including the treatment schedule, potential side effects, and instructions for managing those side effects.

It's crucial to follow your doctor's instructions carefully during the preparation process to ensure that your IGRT treatment is as safe and effective as possible. Don't hesitate to ask questions if you have any concerns or uncertainties.

The Image-guided radiation therapy (IGRT) Procedure

The IGRT procedure itself is a relatively straightforward process that involves several key steps. Here's a detailed explanation of what you can expect during each treatment session:

• Positioning: At the beginning of each session, the radiation therapist will carefully position you on the treatment table, using the skin marks or positioning device created during the simulation session. It's crucial to lie still and maintain the same position throughout the treatment.

• Imaging: Once you are positioned correctly, the radiation machine will take images of the treatment area. These images may be X-rays, CT scans, or other types of imaging scans.

• Image Comparison and Adjustment: The images taken during the treatment session are compared to the reference images obtained during the simulation session. If there are any discrepancies between the two sets of images, the radiation therapist will make adjustments to your position or the radiation beams to ensure that the radiation is targeted precisely at the tumor.

• Radiation Delivery: Once the imaging and adjustments are complete, the radiation beams will be delivered to the tumor. The radiation delivery process is painless and typically takes only a few minutes.

• Monitoring: During the radiation delivery, the radiation therapist will monitor you closely through a closed-circuit television system. They will also be able to hear you through an intercom system. If you experience any discomfort or have any concerns during the treatment, you can communicate with the therapist at any time.

• Treatment Duration: Each IGRT treatment session typically lasts between 15 and 60 minutes, including the time it takes for positioning, imaging, and radiation delivery. The actual radiation delivery itself usually takes only a few minutes.

• Treatment Schedule: The number of IGRT treatment sessions you will need depends on the type, size, and location of your tumor, as well as your overall health. Typically, patients receive IGRT treatments daily, Monday through Friday, for several weeks.

• 4D-RT (If Applicable): If you are undergoing 4D-RT (a specialized type of IGRT that accounts for tumor movement due to breathing), the radiation machine may switch off automatically if the tumor moves out of the radiotherapy field. The machine will switch back on when the tumor returns to the correct position. This ensures that the radiation is delivered only when the tumor is within the target area.

Throughout the IGRT procedure, the radiation therapists will work closely with you to ensure that you are comfortable and that the treatment is delivered accurately and safely. Don't hesitate to ask questions or express any concerns you may have.

Understanding Results

The results of IGRT are evaluated based on several factors, including tumor response, side effects, and overall survival. IGRT aims to improve the accuracy of radiation therapy, which in turn can lead to better outcomes.

• Increased Accuracy: IGRT significantly improves the accuracy of radiation field placement. This means that the radiation beams are more precisely targeted at the tumor, minimizing the amount of radiation exposure to surrounding healthy tissues.

• Reduced Exposure to Healthy Tissue: By precisely targeting the tumor, IGRT reduces the risk of radiation damage to healthy tissues. This can lead to fewer side effects and a better quality of life for patients.

• Tumor Response: Doctors will monitor the tumor's response to IGRT through regular imaging scans, such as CT scans, MRI scans, or PET scans. These scans will help to determine if the tumor is shrinking, remaining stable, or growing.

• Improved Survival Rates: Studies have shown that patients receiving daily IGRT have improved survival rates compared to those receiving IMRT (Intensity-Modulated Radiation Therapy) alone. Local progression-free survival is also higher with IGRT.

• Side Effects: Radiation treatment can cause side effects, resulting from the treatment itself or from radiation damage to healthy cells in the treatment area. Side effects depend on the type of radiation, dose, and body part being treated. Common side effects may include fatigue, skin changes (irritation), nausea and vomiting, diarrhea. These side effects are typically temporary and can be managed with medication and supportive care.

• Long-Term Outcomes: The long-term outcomes of IGRT depend on various factors, including the type and stage of cancer, the patient's overall health, and the effectiveness of the treatment. Your doctor will discuss the potential long-term outcomes with you before you begin IGRT.

It's important to have realistic expectations about the results of IGRT. While IGRT can significantly improve the accuracy and effectiveness of radiation therapy, it's not a cure for cancer. The goal of IGRT is to control the growth of the tumor, reduce symptoms, and improve the patient's quality of life. Regular follow-up appointments with your doctor are essential to monitor your progress and manage any potential side effects.

Costs in India

The cost of IGRT in India can vary depending on several factors. It's crucial to have a clear understanding of the potential expenses involved before starting treatment.

• Factors Affecting Cost: The cost of IGRT in India depends on several factors:

  • Hospital and Facilities: The type of hospital or treatment center you choose can significantly impact the cost. Private hospitals and specialized cancer centers typically charge more than public hospitals.
  • Oncologist's Fees: The fees charged by the radiation oncologist can vary depending on their experience and expertise.
  • Complexity of the Procedure: More complex cases that require more intensive treatment planning and monitoring may cost more.
  • Type of Cancer: The type and stage of cancer can affect the cost of IGRT. Certain types of cancer may require more extensive treatment.
  • Number of Treatment Sessions: The number of IGRT treatment sessions you need will directly impact the cost. More sessions will result in a higher overall cost.
  • Dosage Required: The radiation dosage required can also influence the cost. Higher dosages may require more sophisticated treatment planning and monitoring.
  • Additional Services: Additional services, such as consultations, imaging scans, medications, and supportive care, can add to the overall cost.

• Cost Range:

  • Generally, IGRT costs in India range from $3,000 to $8,000 USD (approximately ₹2,40,000 to ₹6,40,000 INR). This is a broad estimate, and the actual cost may vary depending on the factors mentioned above.
  • Some sources suggest costs between INR 1,92,000 to INR 2,49,600.
  • Max Healthcare states that IGRT at their hospitals starts at $5000 (approximately ₹4,00,000 INR).

• Cost-Effectiveness: Despite the cost, IGRT in India is generally considered to be more cost-effective compared to Western countries. The lower cost of labor and healthcare services in India makes IGRT a more affordable option for many patients.

• Insurance Coverage: Check with your health insurance provider to determine if IGRT is covered under your policy. Many health insurance plans in India cover radiation therapy, but the extent of coverage may vary.

• Financial Assistance: Explore options for financial assistance, such as government schemes, charitable organizations, or crowdfunding platforms. Some hospitals and cancer centers also offer financial assistance programs to help patients afford treatment.

• Cost Transparency: It's crucial to get a detailed cost estimate from the hospital or treatment center before starting IGRT. This estimate should include all potential charges, such as consultation fees, imaging costs, treatment fees, and medication costs.

• Payment Options: Discuss payment options with the hospital or treatment center. Many hospitals offer installment plans or other payment arrangements to help patients manage the cost of treatment.

It's important to remember that the cost of IGRT is an investment in your health and well-being. By carefully considering your options and exploring all available resources, you can make an informed decision about your treatment.

How Ayu Helps

Ayu simplifies managing your medical records related to IGRT, ensuring you have easy access to your reports and treatment plans for consultations and follow-ups.

FAQ

Here are some frequently asked questions about IGRT:

1. Is IGRT painful?

No, IGRT is not painful. You will not feel anything during the radiation delivery. However, you may experience side effects from the radiation, such as fatigue or skin irritation.

2. How long does each IGRT treatment session take?

Each IGRT treatment session typically lasts between 15 and 60 minutes, including the time it takes for positioning, imaging, and radiation delivery. The actual radiation delivery itself usually takes only a few minutes.

3. What are the side effects of IGRT?

The side effects of IGRT depend on the type of radiation, dose, and body part being treated. Common side effects may include fatigue, skin changes (irritation), nausea and vomiting, and diarrhea. These side effects are typically temporary and can be managed with medication and supportive care.

4. How many IGRT treatment sessions will I need?

The number of IGRT treatment sessions you will need depends on the type, size, and location of your tumor, as well as your overall health. Typically, patients receive IGRT treatments daily, Monday through Friday, for several weeks.

5. Is IGRT covered by insurance in India?

Many health insurance plans in India cover radiation therapy, including IGRT, but the extent of coverage may vary. Check with your insurance provider to determine if IGRT is covered under your policy.

6. How does IGRT differ from traditional radiation therapy?

IGRT uses imaging techniques during treatment to precisely target tumors, while traditional radiation therapy relies on external landmarks and pre-treatment imaging. This improved accuracy of IGRT allows for higher doses of radiation to be delivered to the tumor while minimizing damage to surrounding healthy tissues.

7. What if I move during the treatment?

The radiation therapists will monitor you closely throughout the treatment session. If you move significantly, they may stop the treatment and reposition you to ensure that the radiation is delivered accurately. In 4D-RT, the machine can automatically switch off if the tumor moves out of the radiotherapy field.

8. How do I know if IGRT is the right treatment option for me?

Your doctor will conduct a thorough consultation and physical examination to assess your overall health and determine if IGRT is the right treatment option for you. They will consider the type, size, and location of your tumor, as well as your overall health and preferences.