Radiation Therapy or Radiooncology plays an important role in the treatment of malignant diseases. Nowadays, about 45 to 50% of all people who suffer from cancer (children and adults) can be cured with the help of modern treatment procedures. 50 to 60% of those who have been cured have undergone radiotherapy as part of their treatment.
It is carried out either as radiotherapy alone or in combination with surgical measures and/or chemotherapy. Most patients and many physicians often do not understand well enough that radiation therapy makes a significant contribution to curing cancer or is even the decisive part of treatment.
Overmore Radiation Therapy plays an important role in alleviating the symptoms of cancer disease. Many patients who can no longer be cured benefit from pain relief or restoration of body functions (e.g. ability to swallow, ability to walk). For these patients, their disease should be considered as chronic, which requires therapy measures at various intervals.
In our joint practice for radiology and radiooncology, the Radiologische Allianz offers highly modern diagnostics and Radiation Therapy for diseases of the locomotor system, of the bones, of the lungs, area of the head and neck, of the brain, abdominal and pelvic organs. Our area of specialization is diagnostics and treatment of tumour diseases.
Thanks to our various diagnostic possibilities, we can perform an individually planned treatment of tumour diseases. Cooperating closely with colleagues from various fields, we can offer you the best possible diagnostics and radiooncological therapy. It is important for us to treat you with the best possible professional competence. You should feel at ease to ask questions, to express your wishes and concerns. Our practice team is always available to help you.
The goal of the treatment is to remove the tumour completely. To achieve this we need a certain radiation dose, which varies according to the type of tumour, tumour size, surrounding normal, healthy tissue and the individual disease situation. As a rule, that means that the treatment lasts for a long period of time. In a few individual cases, a single irradiation session can be enough. The radiation therapy is a local therapy measure similar to a surgical intervention. Its effect and side effects are limited to the body regions that have been irradiated.
In order to carry out the radiotherapy as gently as possible, it is in the most cases administered gradually, which means small portions of the entire dose are irradiated every day. This way, the destruction of the tumour cells and a better protection of surrounding normal and healthy tissue can be achieved. The size of the single dose and the entire dose and the size of the irradiation field depend on the type and extent of the tumour disease. Thanks to the modern imaging systems (CT, MR, PET/CT), the irradiation planning and highly developed linear accelerators, the treatment can be carried out with high precision, very effectively and gently. High-energy x-rays (photons) and electrons that are generated by means of a linear accelerator, are applied. With the help of physical methods, the dose distribution in the body can be calculated individually and precisely for each patient. The patient will not undergo radiation exposure.
Alleviating pain using Radiation Therapy in the case of benign diseases
The therapy with x-ray is applied not only for the treatment of malignant tumours - it also plays an important role in pain therapy.
A low-dose Radiation Therapy is a very effective method for treating painful, degenerative-inflammatory diseases of the skeleton. Therefore it is a good alternative or supplementation to other conservative treatments.
Intraoperative Radiation Therapy (IORT) is used both as radiation therapy on its own during an operation to conserve the breast, and as a boost therapy (dose saturation on a small area in the area which is at highest risk of a relapse) followed by several weeks of fractionated radiation therapy of the entire mammary gland.
1. IORT on its own
Thanks to the results of recent studies (Vaidya, Wenz et al. Lancet 2013) IORT alone can now take place outside of studies, on selected patients at relatively low risk of relapse. These includes patients who are 70 or older, and who have had an NST type mammary carcinoma (non special type; formerly referred to as an invasive ductal carcinoma) removed, which was a maximum of 2cm in diameter and had no risk factors such as lymph node infestation. In such cases, additional radiotherapy of the entire mammary gland is not necessary once the wound has healed completely.
2. IORT as a boost treatment followed by several weeks of fractionated radiotherapy of the mammary gland
Regardless of the patient’s age, tumour size and histology, or the position of the tumour in the mammary gland, IORT can be used as an immediate radiotherapy boost treatment for certain breast cancer carcinomas. This means that the period of subsequent radiotherapy on the whole mammary gland is shortened somewhat, so the heart and lungs can be even better protected. The risk of relapse appears to be especially low here. The risk of significant wound healing disorders can be slightly raised, but these only occur rarely. If chemotherapy is considered necessary, this will be carried out first. Following this, the affected mammary gland is treated with radiation therapy.
IORT is offered in cooperation with Hamburg Breast Centre and the AGAPLESION Diakonieklinikum Hamburg.
Technology and flow of Intraoperative Radiotherapy
Intraoperative Radiotherapy is conducted with the intrabeam system from Zeiss, Oberkochen. A small x-ray tube is coupled to a mobile and free swivelling stand. Ball-point applicators of different diameters corresponding to the size of the wound cavity are connected to the x-ray tube and placed directly into the wound cavity. Afterwards, irradiation is conducted with the dose fraction of 50 kV (no special radiation protection required!) over a period of time of 20 to 53 minutes (depending on the diameter of the ball applicator) with the radiation dose of 20 Gy measured at the surface of the ball-point applicator.
PET/CT (Positron-Emission-Tomography and Computed Tomography)
PET/CT – the most modern diagnostic procedure in oncology – reliably tracks down cancerous cells due to their increased metabolism, thus making it possible to diagnose cancer precisely, while it is still in its early stages.
The PET/CT is a combination of Positron-Emission-Tomography (PET) and Computed Tomography (CT) in one device. It combines two different imaging techniques, which makes it possible to provide an exact image of the body structure and function in one and the same image. The exact location, size, activity and spread of a tumour within the body can be determined. During a single examination under the same conditions, different advantages of both methods supplement each other, creating a good image and helping to make a precise diagnosis. Studies have shown that accuracy of diagnosis based on a combined PET/CT examination results has increased compared with two scans performed separately. For you as a patient, in addition to the optimal diagnosis there is one more advantage - only one examination appointment is needed and the examination time is half that of the separate examinations.
PET is a nuclear medical procedure which in most cases uses the low-active radioactive substance similar to dextrose F-18 fluorodeoxyglucose (FDG). Our body cells need dextrose (glucose) as a fuel, and it accumulates in many cancer cells because they grow fast and have a significant demand for fuel. The PET camera produces a picture of the distribution of sugar within the body: the healthy tissue takes up very little glucose, so „cancer cells“ can be identified. They can be recognized early and definitely with the PET, but their exact size and position cannot be determined exactly. The data is presented in a form of cross-sectional images, full-body images and three-dimensional images.
CT is an established x-ray procedure which uses x-rays to create finely structured layered images of the body. In some cases it is necessary to use a contrast agent in order to create clearer images. The CT can be used to precisely define the size and position of the focal point of the cancer, but it is often not able to differentiate well enough or early enough between healthy tissue and cancerous tissue.
PET/CT and Radiotherapy
PET/CT is an important planning tool for radiation therapy. When planning Radiotherapy based on merged data provided by PET/CT, the target volumes can be defined even more precisely. The exact localization of the radiation field makes it possible to provide individual treatment and improve the chances of recovery.
Magnetic Resonance Imaging (MRI) is a medical imaging technique used primarily in medical diagnostics to visualize internal structure, the function of tissues and body organs.
MRI uses electric and magnetic fields. The high-frequency pulses (radio waves) stimulate atoms with an odd mass number (dipoles) in the human body, so that they vibrate. Different types of tissues of the body are determined by different so-called relaxation times. In this way, the contrasts between organs and tissues are made visible.
Images showing the body on each possible level depict all organs in detail, thus meaning that potential pathological changes can be recognized.
The process is performed completely without x-rays. However, in Germany it may only be used by radiologists.
This method makes it possible to examine your blood vessels without surgical intervention. With the help of the magnetic field technique, we create a three-dimensional model of your vessels so we can see if everything is running “smoothly” there. It helps to recognize narrowing and tissue weaknesses (aneurysms) that may cause circulation problems, stroke or bleeding. The MR Angiography is so advanced that its image quality is the same as that of conventional angiography. In case of specific problems beyond vasoconstriction, e.g. in an upper or lower limb artery, MR Angiography provides more precise information than conventional angiography does.
Advantages of MR Angiography compared with X-ray Angiography (DSA)
The standard method of examination used to be X-ray Angiography. For this purpose, a thin tube (catheter) was inserted from the groin into the artery. While x-ray contrast media was injected through the catheter under high pressure, we would create x-ray images which depicted the blood vessel filled with contrast agent.
MR Angiography no longer requires inserting a thin tube (catheter) from the groin into the artery. This saves approximately four hours of semi-hospitalization. In MR Angiography a contrast agent is injected into the vein. In addition to that, no x-rays are used in MRAngiography, but the vessels are visualized with the help of a strong magnetic field.
Advantages of MR Vessel examination
In MR Angiography, no catheter is inserted into the femoral artery. The contrast material is injected only into the arm vein.
In the case of specific problems, MR Angiography provides more detailed information than the regular x-ray angiography.
The examination is done quickly and without semi-hospitalization.
There are no problems such as bleeding or clotting disorders.
MR Angiography does not use x-rays. The vessels are shown with the help of a strong magnetic field.
The contrast agent used in MR Angiography does not contain iodine and can therefore be used for patients suffering from hyperthyroidism.
The procedure is completed without x-rays. However, in Germany it may only be performed by radiologists.
The focus of the practice is on musculoskeletal imaging in order to diagnose acute and chronic illnesses of the whole musculoskeletal system in adults and children. Cartilage is of central significance for the integrity of the joints. Using ultra-high-resolution MRT, an unparalleled image can be created of the deterioration of cartilage – even in its early stages. An exact diagnosis forms the basis for early and efficient treatment. Of course, we also offer measurement of bone density for the early recognition or progress and therapy monitoring of osteoporosis.
In Germany, Computed Tomography may only be performed by radiologists.
Unlike a regular x-ray examination, CT creates not only a simple silhouette, but also a cross-sectional image of the corresponding organ or body section. One or two x-ray sources rotate around the affected body part during recording, while the opposite x-ray detectors collect the weakened beams left after having gone through body structures (organs, bones, soft tissue).
Converted into digital data, this information provides a slide by slide picture of an anatomical cross-section that can be reconstructed and viewed on the screen.
In exceptional cases when MR Angiography cannot be performed, for example due to a pacemaker, we also offer CT Angiography. This, however, is carried out by using an iodinated contrast agent and x-rays. But the contrast agent is only injected into your arm vein and no catheter is inserted into the groin. Therefore, the CT Angiography procedure is performed as quickly as the MR Angiography. It does not require any follow-up, so you can take up your usual activities after examination. In general, this examination does not differ a lot from the MR Angiography.
Periradicular Therapy (PRT) is a form of therapy that can be used in case of chronic back pains which are caused by changes in the intervertebral discs (e.g. herniated disk). The treating physician inserts a thin needle into the area of the nerve root and/or into the small vertebral joint. When the needle is correctly positioned, which is checked by computed tomography, a mixture of a local anaesthetic, a cortisone preparation and an x-ray contrast agent are administered. The medication is only active in the nerve root. An effect on the whole body is almost excluded. The intervention is carried out under local anaesthesia.
We carry out this procedure with the help of multislice computed tomography (multislice CT). Therefore, we are able to precisely check the position of the tip of a needle and we can treat the area causing pain very precisely. It is also possible to distinguish other structures such as blood vessels, bones and muscle tissue, in order not to damage them.
After four to six sessions, the patient will suffer from much less pain or will be completely pain-free.
X-rays are electromagnetic waves which are produced with an X-ray tube for medical purposes. In German, they are named after Wilhelm Conrad Röntgen, who discovered them in 1895 in Würzburg. In the x-ray system, the x-rays developed by it are sent through the body area being examined, and then the photons let through are transmitted to a digital detector system for the development of an image. The dose is accurately recorded and documented.
The dose the patient is exposed to during an x-ray examination, is kept as low as possible. Compared with the early 20th century, less than 1 percent of the radiation dose needed at that time is needed today for creating an x-ray image.
The Radiologische Allianz has switched completely to digital radiography. The advantages are the lower radiation dose and the fact that it is possible to save the image in a digital archive. We can mostly forgo usual x-ray images. Patients will receive prints and a CD, on which the data are saved instead. So the patients can look at the results of their examination on any modern PC or tablet.
With the help of the magnetic resonance imaging it is possible to see the small intestine. Thus, MRI is an alternative to conventional examination of the small intestine with enteroclysis. There is no need to insert a probe into the small intestine.
MRI helps to visualize not only changes in the inner bowels, but also thickening or inflammation of the bowel wall and its environment. The examination is used to diagnose inflammatory bowel diseases such as Crohn’s disease and ulcerative colitis, the infestation and the extension of the disease.
The procedure is performed completely without x-rays. However, in Germany it may only be performed by radiologists.
The examination of the prostate with the help of magnetic resonance imaging (MRI) is a modern diagnostic method to combat prostate cancer. This method combines several advantages: firstly, the organ to be examined can be visually separated into different layers of tissue. Furthermore, it is non-invasive and, unlike the computer tomography, x-rays will not be used to create images. The examination of the prostate is performed with the help of two coils. The painless insertion of the endorectal coil into the rectum makes it possible for the probe to approach the prostate and thus create high-resolution imaging.
The procedure is performed completely without x-rays. However, in Germany it may only be performed by radiologists.
Who is this examination for?
For men who have an increased PSA level
For men whose tissue sample taken after a PSA increase was benign, but their PSA level continued to increase (MRI prostate biopsy before second punchbiopsy)
As additional guidance for the upcoming decision on treatment (e. g. surgery, radiotherapy, hormonal therapy?) for men with histologically diagnosed prostate cancer.
When, after removing the prostate, the PSA level rises again. Is this a local recurrence? Is there a lymph node enlargement in the pelvic area? Many radiation therapy institutions require this cross-sectional imaging procedure before the start of therapy.
Advantages and disadvantages of Prostate MRI
No x-rays are required.
A tumour, and in particular the question of the size and advancement of a prostate cancer in its surrounding. The infiltration of the seminal vesicles is safer with MRI than with other cross-sectional imaging methods.
The lymph nodes of the pelvis and especially the regional lymph nodes in the immediate vicinity of the prostate gland can be detected with high resolution on three levels with the endorectal coil.
Disadvantage: In the past, severe inflammation of the prostate (prostatitis) could be similar to morphologic carcinoma and a tumour.
Nowadays, lung cancer can be diagnosed reliably and in a very gentle way, using so-called low-dose computed tomography. With the help of modern technology, tumours with a diameter of only a few millimetres can be detected.
The process is very suitable as an early recognition method for patients with an increased risk of lung cancer (e.g. heavy smokers). Initial studies show that many very small (< 20 mm), lung tumours can be diagnosed, which are easily operable and therefore curable.
In addition to its use as an early detection procedure for lung cancer, depending on the question to be answered and the patient’s physique, we also use low dose CT of the lung to clarify illnesses which affect the lungs only (i.e. asbestosis, sarcoidosis), and to look for tumours in high-risk patients.
Advantages and disadvantages of lung cancer early recognition with computed tomography
The low-dose CT in multilayer technology is considered to be the most sensitive method for early recognition of lung cancer.
The low-dose CT increases the chances of recovery since lung tumours can be detected in very early stages.
With the help of low-dose CT, lung cancer tumours that „hide“ behind vessels and diaphragm domes can also be recognized. The conventional methods do not detect these tumours.
With the help of computer-assisted analysis of the CT data we perform as a standard measure, the size of a tumour can be accurately measured and the smallest changes can be detected. By means of a CT follow-up examination at three to six month intervals, benign tissue changes can be differentiated from malignant ones based on a lack of growth.
The introduction of new detector systems makes it possible to perform lung examinations with a very low radiation dose. With the multi-slice CT technology, the radiation exposure is approximately 0.2 to 0.6 mSv. By way of comparison: every citizen in Germany is, on average, exposed to a radiation dose of about 2.5 mSv from the environment every year.
Osteoporosis, or weight reduction of the bones, is the most common bone disease in older patients. Bones become more susceptible to breaks. In 95% of all cases primary osteoporosis is diagnosed. Unlike secondary osteoporosis, this kind of osteoporosis does not occur as a result of another disease. 80% of all osteoporosis cases affect post-menopausal women. Secondary osteoporosis (5%) occurs rarely, and is associated with diseases that require long-term treatment with cortisone.
Bone Density Measurement by means of dual-energy x-ray absorptiometry (DXA) is the golden standard in the diagnostics of osteoporosis and enables bone density to be measured in accordance with the guidelines of the umbrella association of osteology (DVO). This includes carrying out measurements in the areas of the lumbar spine and femoral head.
The measurements are carried out using a new generation device produced by General Electric (GE Lunar Prodigy). The radiation exposure does not have to be considered, as it is comparable to the natural radiation exposure of one day.
Alongside the diagnosis of bone density, the examination includes an individual report including modern graphics and a thorough evaluation.