Radiotherapy at the Casa di Cura San Rossore has:

• Computed tomography (Siemens Open Sensation CT), 64 multislice, entirely dedicated to radiation therapy
• TrueBeam STx linear accelerator (see photo gallery above) from Varian Medical System, equipped with an integrated “cone beam CT” device that allows to perform, prior to treatment, a radiological evaluation thanks to which it is possible to monitor the real position of the tumor target and critical organs, correct any positioning errors, and evaluate any displacements even millimeters of the tumor target due to the often non-eliminable movement of internal organs ( organ motion ) and thus irradiate with greater precision.

The TrueBeam STx also has a micro-multilamellar system that allows for high-precision cranial and extracranial stereotactic treatments and, thanks to the machine’s ability to deliver X-radiation even in the FFF (Flattening Filter Free) mode, to decrease the time of dose delivery and thus of the treatment itself

RADICAL-CURATIVE:

• As an exclusive therapy:
  • treatments with conventional fractionations
  • hypofractionated treatments i.e., the ability to deliver high doses with the same or higher therapeutic efficacy thus reducing the overall duration of treatments compared to more traditional schemes
• As combination radiotherapy, integrated in various modalities with surgery (preoperative, intraoperative, postoperative) or in combination with chemotherapy (neoadjuvant, concomitant, sequential), or in combination with hormone therapy or immunotherapy

PALLIATIVE-SYMPTOMATIC:To decrease and/or eliminate symptoms due to neoplastic disease such as pain , compressive syndromes (e.g. mediastinal syndrome, spinal cord compression, etc..) or rarely otherwise uncontrollable bleeding, and/or combined with other therapeutic weapons.

RADIOTHERAPY OF BENEFICIAL LESIONS:For example, pituitary adenomas, meningiomas, arteriovenous malformations (AVMs), Basedow’s disease, keloids, aneurysmal cysts, cranial nerve pathologies (e.g. trigeminal), vascular pathologies.

Clinical evaluation Oncology:

The first contact between the patient and the Center occurs with the first visit to the Radiotherapy Department (“Radiotherapy Oncology Consultation”). During the consultation, the radiation oncology oncologist collects all information, through medical records, about the patient’s current and remote health status to determine the nature and extent of the disease thus proceeding to multidisciplinary consultations.

Once the clinical issue is identified, the radiation oncologist analyzes the possibility of radiation treatment, choosing the most suitable delivery modality for the individual patient, in consultation with colleagues in Medical Physics.

Centering TC:

Upon accepting the patient for radiation therapy, the Radiation Oncologist and the Medical Radiology Health Technician (TSRM) perform a centering CT scan by defining the patient’s position on the couch and determining the type of immobilization system best suited for the type of therapy to be delivered.

Contornation:

Next, the radiation oncologist identifies the sensitive structures to be contoured on the centering CT scan. To do this it also uses information from other diagnostic investigations such as MRI and PET. Thanks to modern software in the Center, the radiation oncologist has the ability to “fuse” all the patient’s diagnostic images, managing to pinpoint with millimeter precision the region to be irradiated.

Development of the treatment plan:

The Medical Physicist prepares the Treatment Plan by optimizing the dose in the target volume while trying to spare the healthy organs surrounding the disease as much as possible. Each patient will therefore have a Care Plan that is strictly individualized, and suitable for achieving the most accurate dose distribution; consequently it will be different from that of any other patient. After the planning is finished, the Medical Physicist presents the plan to the Radiation Oncologist, which will be analyzed, discussed, possibly modified, and accepted.

Before being dispensed on the patient, the Plan is verified on the ArcCheck dummy (for verification of rotational treatments) by evaluating its correct dose delivery (step in the overall Quality Control pathway)

Verification of positioning and treatment:

To carry out the treatment session, the patient is introduced inside the room (Bunker) where the linear accelerator is housed and is made to lie on the treatment couch. A CT scan is taken of the region to be irradiated before radiation is delivered and compared with the centering CT scan. With this procedure, it is possible to position the patient with millimeter precision.

The patient inside the therapy room is constantly monitored by the TSRM through a closed-circuit video system. In addition, an intercom system via intercom allows the patient to communicate with the technician. Throughout the radiotherapy treatment, the Patient will undergo follow-up visits during which any supportive therapy will be prescribed. Periodic follow-up visits are carried out after the conclusion of treatment.

Radiation treatment is performed either on an outpatient basis or on an inpatient or day-hospital basis for special clinical cases or for ‘performing combination therapies ( e.g., chemotherapy, nutrition, supportive medical therapy). Admission to ward or dedicated housing is also possible for special logistical situations (Click here to browse our solutions for your stay)

Radiation Therapy collaborates both within the Casa di Cura within dedicated Multidisciplinary Groups and with the various specialists at other National Centers for the discussion of the most complex clinical cases to ensure that each patient receives the proper integration and personalization of planned treatments based on international protocols and guidelines interior adapted to the clinical situation of each individual patient.

The Physician verifies and evaluates all the parameters of your treatment plan, verifies every radiological image performed before and during treatment including by Cone Beam verifications at the time of treatment for correctness of therapy; performs intercura

The medical physicist:

It ensures through periodic checks that the characteristics of the equipment are within the tolerance levels chosen to ensure the optimal performance of treatments. It ensures the treatment pathway: from the preparation of the treatment plan, to its approval following discussion with the physician, from the transfer of the plan to the treatment machine through the Record and Verify (ARIA) system that allows the identification of the patient, the correct association of his or her treatment plan and the recording of the dose delivered to each fraction, to the verification before the start of the treatment of the correct delivery of the plan by the equipment and also supervises with other working figures (physicians and technicians) during treatments with respiratory gating.

The TSRM health technician:

Works according to the instructions of the radiation oncologist at the various stages of the radiation therapy procedure: performs patient set up, if necessary using positioning and immobilization systems; during the simulation phase of the treatment, acquires the images necessary for the production of the treatment plan and prepares the accessories necessary for its implementation (shielding, etc.); performs the radiation treatment according to the indications of the plan prepared and approved by the physicist and physician and is responsible for the correct application of the plan itself; acquires the images produced with IGRT technology and assists the radiation oncologist in the “on line” control for the correction of the set up. Prior to the start of treatment carry out the check together with the physicist of the correct delivery of the plan by the machine.

Mammography with tomosynthesis, also known as 3-dimensional mammography, is an innovative 3-D technique that reduces the number of false negatives compared with examinations performed with a 2-D technique.

3D mammography represents a high-definition three-dimensional version of digital mammography.

The new mammography, also known as digital breast tomosynthesis, represents a breakthrough in diagnostics: the basic principle is the same as tomography: it makes use of images captured from different angles, with reconstructions of volumetric figures, thus enabling the physician to detect any abnormalities or pathologies that would otherwise be undetectable.

In practice, unlike a normal mammogram, where the machine is fixed, in tomosynthesis the instrumentation moves around the breast. Volumetric reconstruction, in principle, makes it possible to overcome one of the main limitations of two-dimensional imaging and thus of radiological imaging (digital mammography) currently in use, namely the masking of lesions (masses, microcalcifications, distortions, etc.) caused by the superimposition of normal structures. This situation occurs most often in young patients with radiologically dense breasts. The advantage of this is that it is easier to find any hidden tumor tissue.

The opportunity, in fact, to dissociate different planes by tomosynthesis makes it seem possible to reduce the number of false negatives and false positives, due to the overlap, allowing a substantial improvement in the detection and analysis of lesions: conviction of their presence and certainty of their absence.

Digital mammography is a diagnostic method that uses equipment called a digital mammograph to form the mammographic image.

In digital mammography, the X-ray film is replaced by a detector: this absorbs X-rays transmitted through the breast and converts their energy into electronic signals, which are digitized and fixed in computer memory. An image, the digital mammogram, is then derived from this set of data and displayed on a high-definition monitor. From there, after being properly processed, it can be imprinted on film using a laser printer or stored in one of the various storage systems available today, including CD-ROM.

It lasts a few minutes and no drugs are administered or contrast medium used. Mammography is the most effective and safe means of early detection of breast cancer. In fact, it helps to detect small changes in the breast before other signs or symptoms appear. If such changes are noticed early, there is a very good chance of full recovery.

Advantages:

• Optimization of ionizing radiation dose
• Image modifiability by processing
• Display on monitor and on film
• Digital archiving: exams remain stored within facility computers for later comparison
• Remote transmission

Ultrasound is a method that uses ultrasound that is sound waves of frequencies above 20,000 Hz that are inaudible to the human ear. This makes the examination harmless and repeatable. Ultrasound equipment uses probes, called transducers, that emit ultrasound beams that pass through the various tissues of the human body and generate reflected beams that return to the transducer and are called return echoes. In senology, ultrasonography effectively accompanies and complements the mammographic examination and, above all, represents a supplement to the clinical examination (breast examination) , which no longer has any reason to exist without instrumental support such as ultrasonography that makes immediately visible what is manifested by palpation. Ultrasound is the investigation of first choice in women younger than 40 years of age, in whom the still predominantly glandular structure of the breast does not make study by mammography effective. The periodicity of the ultrasound examination is decided by the radiologist on the basis of the patients’ registry age, family history (presence of relatives with breast cancer disease), pathological history, current or previous hormone therapy, and mammary gland structure.

Advantages:

• High frequency 10-13 MHz probes with high image definition
• State-of-the-art ultrasound machine
• Software dedicated to breast study
• Echocolordoppler study

The detection of doubtful and/or suspicious lesions results in the need for histological characterization, which is a key step in the patient’s subsequent course of action.

The stereotactic tomosynthesis IMS biopsy is performed in the prone position, in clinostatism (lying down), and allows localization and guided RX retrievals of otherwise unreachable findings.

The finding obtained by tomosynthesis biopsy is the same as that detected by 3D mammography, which is otherwise not always detectable by the 2D technique, due to the masking phenomenon discussed above. It is therefore a rapid biopsy procedure devoid of the discomfort inherent in sitting biopsy and therefore better tolerated by women.

With this system, the lesion can be reached from various angles, and the layer of interest is brought into focus.

The innovation present at the Casa di Cura San Rossore in Pisa, a center of excellence in Tuscany, consists precisely in the prone position, the rapidity of the examination and the lower dose of ionizing radiation administered during the examination.

A breast interventional procedure is defined as any minimally invasive act performed on the mammary gland that is intended to condition the subsequent diagnostic or therapeutic course. The choice of the best method is customized by the radiologist based on the characteristics of the pathological finding, its size, and the method by which that finding is best visualized.

Radioguided interventional, mammotome

• Indicated for histological typing of microcalcifications, opacities, distortions and otherwise lesions visible on mammography.
• Computerized guide for withdrawal
• Microhistological sampling with forced aspiration (mammotome) resulting in an abundance of material
• Unlike many other centers where such a procedure is done in the sitting position, stereotactic biopsy at Casa di Cura San Rossore is performed with the patient lying down, prone: clinostatism, that is, the lying position, greatly reduces the discomfort of the procedure compared to the sitting
• Local anesthesia
• Localization of non-palpable lesions

Echoguided interventional

• Indicated in cytohistological typing of lesions visible on ultrasound
• Real-time ultrasound guidance at needle introduction for continuous verification of correct sampling.
• Thin needle: cytological sampling
• Tru-Cut/Mammotome: microhistological sampling
• Local anesthesia
• Speed of execution
• Presurgical localization of non-palpable lesions