Brachytherapy involves radioactive seeds or sources being placed in or near a tumor, providing a high dose of radiation to the tumor while reducing the radiation exposure in the surrounding healthy tissues. Brachy is Greek for “short distance.”

The patient’s neurosurgeon attaches a head frame that allows for great accuracy in targeting the tumor. A planning CT with the head ring in place is performed. The CT is fused with a MRI to allow the neurosurgeon and radiation oncologist the greatest accuracy in targeting the tumor. A treatment plan is generated to optimally treat the tumor while sparing normal brain by using many small, precisely aimed radiation beams that converge at the tumor. All of the radiation is delivered in one day and the patient is able to return home after treatment.

The Mount Sinai Technique involves 3-D conformal radiation therapy and utilizes CT images obtained during simulation to plan radiation therapy. The physicist carefully selects the optimal beam angles to with the goal of delivering highest radiation doses to the target with the lowest possible amount of radiation to nearby structures. IMRT is an advanced form of 3-D conformal radiation therapy where a computer calculates the optimal combination of beams of varying intensities. In many cases, this technique results in a higher dose delivered to the target while nearby tissues receive lower doses of radiation therapy.

Often the treatment recommendation includes external beam radiation as part of treatment. The next step is treatment simulation. 

• Simulation: Radiation therapy must be individualized to the patient’s needs. We ask the patient to return for a treatment planning session called simulation. During this session, the physician, in conjunction with a radiation therapist, will perform at CT scan or multiple x-rays to map out the location of the tumor and surrounding normal tissues. Occasionally, IV contrast or oral contrast will be given to allow the physician to more accurately interpret the CT. The therapist may place temporary markers to outline the tumor and often will create a foam cradle or other device to ensure that the tumor is in the same place for every treatment. The simulation usually takes from 30 to 60 minutes. 
• Treatment Planning: With these images, the physician works with the physicist and dosimetrist to determine how best to treat the tumor, while avoiding nearby normal tissues as much as possible. This is a very involved process in modern radiation therapy. The physician will review the physical examination, all radiology images (CT, MRI, PET/CT, x-ray) and operative reports to determine the extent of the tumor. The physician must also consider sites of possible spread that are not visible with even the most advanced imaging technology. The physician will outline the target area as well as the important normal tissues. In all cases, the physician and physicist will determine the best strategy to control the tumor with the least risk of complications. For certain cases, IMRT or 3D-conformal therapy will be the best approach to treating the tumor. In other cases, conventional radiation is the best treatment. 
• Radiation Therapy: After the physician reviews the treatment plan and prescribes a course of radiation, the patient returns for daily treatment, which generally occurs Monday through Friday for two to eight weeks. High energy x-rays or electrons are produced by a machine called a linear accelerator. The treatments are delivered by a specially trained and licensed radiation therapist. The treatments take only a few minutes to deliver and are painless. However, it takes time to carefully set up the patient accurately every day, so the patient should expect to spend roughly 15 to 45 minutes in our department for each visit. At least once per week, our physicians will examine the patient to assess how the treatment is progressing. The physician, nurse, radiation therapist and other professionals involved in the patient’s care are always available for any needs that the patient may have. A physician is on call 24 hours a day for any emergencies that occur during treatment.

Novalis, BrainLAB's dedicated system for non-invasive stereotactic radiosurgery and radiotherapy (SRS/SRT), represents cutting-edge technology for highly precise treatments of brain as well as head & neck tumors, arteriovenous malformations and certain functional disorders. Novalis Body features image-guided radiosurgery for high precision treatment of body targets. Its X-ray-based localization technology allows physicians to localize tumors with sub-millimeter accuracy and to position patients automatically and with a higher degree of precision than previously possible. With Novalis Body dose escalation protocols and SRT treatments for spine, lung, liver and other body lesions can be carried out quickly and efficiently.

Mount Sinai is the only site in New York City and only one of four in New York state using Novalis shaped beam radiosurgery.