Sanjay Mehta, M.D.

I usually will see patients for consultation. A lot of times the breast surgeon will send them prior to anything being done. So I'll see them for their initial consultation ahead of time.

I usually will see patients for consultation. A lot of times the breast surgeon will send them prior to anything being done. So I'll see them for their initial consultation ahead of time.

But then we plan on doing what's called a planning procedure or a simulation where we're going to put the patient on the table and essentially do a dry run for their treatment, usually a couple of weeks after treatment. And that involves essentially positioning the patient. Typically for a breast patient, they'll be prone with their arm behind their head.

But then we plan on doing what's called a planning procedure or a simulation where we're going to put the patient on the table and essentially do a dry run for their treatment, usually a couple of weeks after treatment. And that involves essentially positioning the patient. Typically for a breast patient, they'll be prone with their arm behind their head.

We call it the movie star pose to get the arm out of the way of the axilla essentially. So by putting them in this position and then putting them on a wing board that'll slightly elevate their torso. And there's a lot of different geometry here that we can use. Back in the old days, they had all kinds of ways of doing plaster casts and things like that.

We call it the movie star pose to get the arm out of the way of the axilla essentially. So by putting them in this position and then putting them on a wing board that'll slightly elevate their torso. And there's a lot of different geometry here that we can use. Back in the old days, they had all kinds of ways of doing plaster casts and things like that.

But we essentially do now, we'll use a, what we call a vac lock, essentially a bean bag with a vacuum port. And the patient sinks into the bag. We suck all the air out of and lock. It becomes a rigid cast of their body. And that way they fit into the groove that we've made for them. We'll actually form it and mold it around their elbow so they're comfortable.

But we essentially do now, we'll use a, what we call a vac lock, essentially a bean bag with a vacuum port. And the patient sinks into the bag. We suck all the air out of and lock. It becomes a rigid cast of their body. And that way they fit into the groove that we've made for them. We'll actually form it and mold it around their elbow so they're comfortable.

Many times with patients who've had an axillary dissection, they may have a little bit of scarring, a little decreased range of motion to be able to get their elbow back there. So we'll work with them the best we can. Whatever position we get them in, we do a CT in that position. And that's the position we have to reproduce for the daily treatment.

Many times with patients who've had an axillary dissection, they may have a little bit of scarring, a little decreased range of motion to be able to get their elbow back there. So we'll work with them the best we can. Whatever position we get them in, we do a CT in that position. And that's the position we have to reproduce for the daily treatment.

And the key there is that when they have their arm out of the way, we have to have room so that the machine can move around from different angles. The actual radiation machine has a gantry that can move really 360 degrees, you can treat from any angle you want, but we have to be able to model tangential beams.

And the key there is that when they have their arm out of the way, we have to have room so that the machine can move around from different angles. The actual radiation machine has a gantry that can move really 360 degrees, you can treat from any angle you want, but we have to be able to model tangential beams.

We don't want direct anterior field that's going to radiate the breast, but the photons are going to go right into the chest. By using an angle, we can cut across the surface and actually shape the beam to match the curvature of the chest wall.

We don't want direct anterior field that's going to radiate the breast, but the photons are going to go right into the chest. By using an angle, we can cut across the surface and actually shape the beam to match the curvature of the chest wall.

So we cover the entire thickness of the breast tissue, or even in the case of an advanced, maybe a T4 patient, something like that, we may even do this post-mastectomy, so you're treating the full chest wall. And we go a little deeper below into the ribs into maybe the first inch of lung tissue below that.

So we cover the entire thickness of the breast tissue, or even in the case of an advanced, maybe a T4 patient, something like that, we may even do this post-mastectomy, so you're treating the full chest wall. And we go a little deeper below into the ribs into maybe the first inch of lung tissue below that.

But by using these tangential beams, that really minimizes the treatment, the photons damaging the lung tissue. So all of that is planned ahead of time.

But by using these tangential beams, that really minimizes the treatment, the photons damaging the lung tissue. So all of that is planned ahead of time.

So post-resection, you'll see a tumor bed. The lumpectomy cavity is obviously clearly visible. It's a fluid pocket on CT. So I'll scan the whole chest. It takes about a week. I have a whole team. I have a wonderful staff, a radiation dosimetrist that helps do the computer planning, and then a radiation physicist that actually calibrates the machine prior to actually starting the patient.

So post-resection, you'll see a tumor bed. The lumpectomy cavity is obviously clearly visible. It's a fluid pocket on CT. So I'll scan the whole chest. It takes about a week. I have a whole team. I have a wonderful staff, a radiation dosimetrist that helps do the computer planning, and then a radiation physicist that actually calibrates the machine prior to actually starting the patient.