There are many individuals involved in the treatment process. Some of these professionals are directly involved with patients while others work behind the scene to provide the necessary services to treat patients. A multi-disciplinary approach often requires coordinating radiation treatments with procedures performed in other departments such as Radiology, Surgery and Medical Oncology. These departments have their own group of professionals to ensure the highest quality medical care. The professionals directly involved with treatments at the NPTC are listed in the sequence of their role in the treatment process.

Radiation Oncologists:
Physicians who specialize in the use of ionizing radiation to treat various types of cancers and malformations. They determine the most appropriate radiation treatment by defining what needs to be treated (disease) and what needs to be avoided (critical organs and tissues). They prescribe the daily and total radiation dose to be delivered to the disease and the dose limits to critical organs. They determine what radiation delivery methods are most appropriate (protons, x-rays, electrons, brachytherapy) to achieve their treatment goals.

Neurosurgeons:
Physicians who specialize in the treatment and diagnosis of various neurological disorders. Neurosurgeons are involved with high-dose, high-precision radiation treatments (radiosurgery) delivered in one or two sessions. Their services are needed to fit patients with certain stereotactic fixation devices as well as implantation of reference markers used for alignment. They also help radiation oncologists with defining neurological lesions.

Anesthesiologists:
Physicians who administer general and local anesthetics, and manage anesthesiological services. They are responsible for determining the anesthetics to be used, considering such factors as patient's age, weight, and medical condition. They monitor the patient’s vital signs and record observations prior, during and after treatments. Their involvement is usually with pediatric patients.

Radiation Oncology Nurses:
Licensed nurses specializing in the care of patients who receive radiation therapy. They assist physicians with various medical procedures including regular health assessments before, during and following treatments. Their regular contact with patient allows them to coordinate treatments with the various social services offered to patients.

Oncology Social Worker:
There are many aspects to undergoing daily radiation treatments for a period of 1-8 weeks. Some patients are from out of town/country and must find lodging. Some patients are local and are trying to maintain as much as is reasonable their daily routine. The role of the social worker is to help patients by providing them with the resources to manage their life during treatments. These include help with lodging, financial services, nutritional services, psychiatric services, education, health/fitness programs, support groups…

Immobilization Specialists:
The role of radiation therapy is to irradiate diseased areas while sparing adjacent normal tissue. If patients weren’t immobilized it would be necessary to treat a margin, which reflects the motion of the diseased target. This would unnecessarily treat normal tissues surrounding the diseased area. This is especially important when using a high precision approach such as proton therapy. The immobilization specialist understands the treatment requirements so as to customize an appropriate device to be used for both the pre-treatment imaging such as a planning-CT as well as the treatments.

CT technologists RT(R):
Licensed radiological technician operate the CT (Computer Tomography) Scanner that is used for planning most of the proton therapy cases. The CT scanner obtains images as if it were slicing through the body like sliced bread. It allows physicians to see internal as well as external anatomy. The radiological technicians administer contrast material that makes internal body parts more visible. They also make sure patients are ready for the imaging procedure.

The CT scan provides physicians with cross-sectional views of the body. Outlining structures on the individual CT images enables the treatment-planning computer to generate a 3D model of the body. This 3D model is used to determine the optimal directions to aim the proton radiation at the targets while avoiding nearby critical structures.

Medical Dosimetrists:
Members of the treatment team who are skilled in calculating and planning doses in radiation therapy. Working closely with the radiation oncologist they generate a treatment plan using sophisticated computer programs. They design special hardware that is used to shape individual proton beams so they conform to the targeted volume while avoiding critical normal structures.

A dosimetrist plans a proton radiation therapy case using sophisticated computer equipment.

Machinists:
Special devices called apertures ensure that only the intended target is irradiated. Compensators further conform the dose to the target shape. Using precision milling equipment the machinists fabricate apertures from brass and the compensators from Lucite for every treatment directions for every patient. The milling coordinates are directly obtained from the treatment-planning computer.

Medical Physicists:
Physicists who specializes in the technical and clinical aspects of radiation therapy. Physicists oversee the technical aspect of the clinical operation of the facility by ensuring that the delivery system, imaging systems, planning systems are functioning properly. They also oversee all aspect of quality assurance and quality control of treatment plans including devices used for patient treatments. In some complicated cases they are directly involved in treatment planning.

Cyclotron Operators:
The cyclotron operators run and monitor the radiation delivery system during treatments. With mechanical, electrical, software, hardware and controls backgrounds they maintain, upgrade and repair the cyclotron and radiation delivery system.

An operator monitors the status of the radiation delivery system in the facility’s main control room.

Radiation Therapists:
Technologists licensed to deliver therapeutic radiation to patients in accordance to a medical prescription. At the NPTC the radiation therapists use x-ray and ultra-sound imaging to ensure patients are set-up for treatment according to the treatment plan. Corrections are made using a robotic treatment table. Patients become very familiar with the radiation therapists since they see them on a daily basis.

While in the treatment room a radiation therapist compares an x-ray image, obtained just prior to treatment, to an image from the treatment-planning CT. Once the treatment position is confirmed the therapists step out of the treatment room and verify the final proton radiation parameters prior to administering the radiation treatment.