Peter LaNasa, MD
Radiation Oncologist
Known for his patient-first approach and expertise in advanced radiation therapy.
Treatment Planning
The few days when nothing appears to happen are what make it safe.
Between your planning scan and your first treatment there is a gap of a few days. It is not a waiting list and it is not a delay. It is your dose being mapped onto a scan of you, and independently checked, before a single beam is switched on.
- Usually a few days
- Mapped on a scan of you
- Checked before delivery
Most insurance accepted and Medicare is welcome. See how referrals, insurance and cost work.
Why the wait exists
What is being done in those few days.
Your anatomy is outlined
The target and every nearby structure that must be protected are drawn, slice by slice, on your own CT scan rather than taken from a template.
The dose is shaped around them
The plan is built and rebuilt until the target has what it needs and the structures around it have as little as the situation allows.
It is checked before it is used
A plan is independently checked before anything is delivered. That check is the reason the gap exists and it is not a step worth hurrying.
It carries through to the room
The approved plan is what the treatment machine is driven from, and what your daily position check is compared against.
In plain words
A map of the dose, drawn on a map of you.
Radiation planning starts from a CT scan taken in the exact position you will be treated in. On that scan your radiation oncologist outlines what is to be treated and what must be avoided. That outlining is done by a person looking at your anatomy, and it is the part that most determines how good the treatment is.
Planning software then calculates how to arrange the beams so the dose lands where it was asked to land. Both of our centers plan in Eclipse, and treatment records and prescriptions are held in ARIA, so what was approved is what the machine is given.
The plan is reviewed and independently checked before your first session. If something does not meet what your oncologist asked for, it goes back and is done again. That is why the gap is measured in days, and it is the least negotiable part of the whole process.
How it works
What happens between your scan and your first session.
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The planning scan
A CT taken in your treatment position, with the marks, mold or headrest that will hold you the same way each day. Nothing is treated on this visit. What happens at that appointment is set out in full on our new patients page.
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Outlining
Your radiation oncologist draws the target and the structures to be protected onto that scan. Where it helps, earlier MRI or PET images are lined up against the CT so the target is defined from everything that is known.
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The plan is built
Beam angles, shapes and weightings are worked out in Eclipse against the dose your oncologist has prescribed, and adjusted until the trade-offs are as good as they are going to get.
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Review and independent check
The plan is approved by your oncologist and independently checked before anything is delivered. This is the step that makes the few days a few days rather than an afternoon.
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Into the treatment room
The approved plan is what runs the machine at every session, and what your daily position check is compared against. If anything about you changes materially during the course, the plan can be revisited.
Most of the work happens before you are in the room.
By the time you lie down for your first session, the difficult decisions have already been made, checked and approved. These few days are the least visible part of your treatment and the least negotiable.
Who this applies to
Every course of radiation is planned. That includes:
- Every course of external beam radiation and IMRT
- Every SBRT and SRS treatment, where the margins are tightest
- Every radiopharmaceutical treatment, planned around the dose you actually receive
- Treatment given to relieve pain, which is planned quickly but is still planned
This is not a service you book or pay for separately. It is part of every course of radiation given here, and it is described on its own page because the few days it takes worry people, and nobody had explained why they exist.
Our doctors
Experienced. Trusted. Focused on you.
Jerry Barker, MD, DABR, FACR
Radiation Oncologist
Focused on precision treatment planning and compassionate, whole-person care.
Questions
What people ask about the wait before treatment.
Why can I not start treatment straight away?
Because your plan does not exist yet. Between the scan and the first session your anatomy is outlined, the dose is arranged around it and the result is independently checked. Starting before that is finished would mean treating you to a plan nobody had verified. For treatment given to relieve severe pain the process is compressed and can move very fast, so if your situation is urgent, say so and it will be treated as urgent rather than as a queue position.
How long does planning usually take?
Usually a few days between the planning scan and the first treatment. More complex plans take longer, and urgent treatment can be arranged much faster. You will be given your actual start date rather than left to guess at it.
Do I need to be there for any of it?
No. After your planning scan there is nothing for you to attend until your first treatment. It is a good few days to sort out transport and parking, and to write down any questions that have surfaced since your consultation.
Can the plan change once treatment has started?
It can. If you lose or gain significant weight, or if a tumor shrinks enough to change the picture, you may be rescanned and replanned during the course. You are seen weekly during treatment partly so that this is noticed rather than missed.
Who actually checks the plan?
Your plan is approved by your radiation oncologist and independently checked before anything is delivered. If you would like to know exactly who checks what in your own case, ask at your consultation. It is a reasonable question and nobody here will be uncomfortable answering it.
Is planning done differently at your two centers?
No. Both centers plan in Eclipse and keep records in ARIA, and both plan from a CT taken in your treatment position. Where you are treated does not change how carefully your plan is built.
Patient stories
In their words.
Dr. Lanasa put me at ease immediately and was zeroed on me at each weekly visit during my eight weeks of therapy. His bedside manner is that of a caring and concerned doctor. Staff, like Dr. Lanasa is second to none.
Above Excellent. This man spent literally 2 hours, explaining to me my treatment plan. He is an extremely optimistic inspiring and informative physician. Extremely compassionate. We need more Doctors like him. Thank you so much.
I am so happy I picked Dr. Barker as my husband's doctor. When we learned my husband oral cancer we were shocked and lost about how to start treatment. Dr. Barker was the first doctor we saw and he led us to my husband's surgeon and oncologist. Dr. Barker explained everything to us and answered all our questions. He is the most wonderful doctor. When a family has to go through cancer it make so much easier when you have a doctor like Dr. Barker. He really cares about his patients and their family.
Prostate Treatment by Radiation Therapy completed at the USMD Prostate Cancer Center in Arlington. Dr. Lanasa is exceptional and his staff is very professional. Technicians are friendly and call patients by name and also get you in and out quickly as they know their business.
The best Professional staff and technition help I have ever been involved with in my 66 years. They save my life.
I picked this guy off the internet for no other reason than he had attended college in my home town and of course was a radiation oncologist which is what I needed. The thing I liked best was his honest and direct answers to all my many questions.He was optimistic and the outcome of the radiation was just as he said it would be. What a lucky choice for me.
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This page is for information and is not medical advice. How long planning takes, and what it involves, depends on your diagnosis and your treatment. Please talk to a qualified physician about your own condition.