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Due to confusion about proper coding throughout the duration of steps of preparing a patient for treatment, ASTRO or the American Society for Radiation Oncology has published an article to set clarifications about the process of care throughout the treatment preparation.

In retrospect, the entire process of care in radiation oncology can narrowed down into six categories:

  1. Patient evaluation
  2. Preparation for treatment
  3. Medical radiation, physics, dosimetry, treatment devices and other special services
  4. Radiation treatment delivery
  5. Radiation treatment management
  6. Follow-up care management

In this article, detailed descriptions and further analysis will be provided for regarding the second step in the process of care in radiation oncology – preparation for treatment.

The preparation for treatment in the process of care consists of three steps:

  1. Clinical treatment planning
  2. Simulation
  3. Isodose planning

Variants of the process of care within the preparation for treatment may also be used. To be specifically discussed in this article are the variances between a 3-D conformal plan and an IMRT plan in the processes of care within the preparation for treatment


  1. Clinical treatment planning

After a thorough evaluation of the patient at consultation, the radiation oncologist in charge will decide whether to administer the radiation therapy to the patient. The initial phase of this process starts with creating a plan for the patient’s therapy from taking a comprehensive evaluation of the patient’s overall condition and extent of disease.

  1. Simulation

The subsequent step after determining the patient’s overall condition and appropriate personal treatment restrictions is creating a visual representation of physically targeting the tumor or other affected area through the use of simulation.

Simulation refers to process of defining a patient’s anatomy through obtaining necessary images and data. This creates an accurate representation of data for the radiation therapist to visualize and manipulate without having to undergo the actual process of treatment.

In a 3-D conformal plan, radiation therapists utilize a computer-generated treatment procedure as a basis for the treatment course while an IMRT plan, on the other hand, includes all simulations services performed in the initial development of the IMRT plan.

  1. Isodose planning

A 3-D Isodose plan is comprised of using computer-generated reconstruction of tissue structures which includes the tumor volume and other affected areas through the use of a CT scan or an MRI scan while isodose planning with an IMRT plan involves capturing visual images and contours within the treatment target, prescription of radiation dose and dosimetric planning, calculation and verification.

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