Radiation oncology (radiotherapy) 011-42060100

Subgroup

Planning items

Re-planning items

Treatment items

1 - Targeted intraoperative radiation therapy

N/A

N/A

15900

2 - Megavoltage

15902 - 15910, 15914, 15918, 15920, 15924 and 15926

15912, 15916, 15922 and 15928

15930 - 15948

3 - Kilovoltage

15950

N/A

15952 - 15956

4 - Brachytherapy

15970 - 15974 and 15978

15976 and 15980

15958 - 15968, 15982 and 15984

Terminology

Explanation

Radiation oncology

A medical specialty that involves the controlled use of radiation to treat various forms of cancer.

Radiation therapy or radiotherapy

This is the actual treatment delivered by a radiation oncology team using x-rays or gamma rays.

Radiotherapy is provided as:

• teletherapy (external source), or
• brachytherapy (a source placed internally in the body)

Radiotherapy services are often referred to as radiation oncology services.

Gamma radiation

A photon produced from radioactive material.

Site

The anatomical location of the tumour in a patient, for example prostate.

Primary site

The primary site or primary tumour is the place in the body where the original type of cancer cell commenced its growth, for example prostate.

Secondary site

A secondary site or secondary tumour is when primary site cancer cells have spread to a second site in the body. For example, cancer cells originating in the prostate may spread to the left lung creating a secondary cancer site in the left lung. This is not a new primary cancer of the lungs but secondary prostate cancer and is defined as a secondary site or metastasis.

Field

The area of the tumour site irradiated in a single application. Radiation beams are delivered at different angles across the tumour site. At each treatment, radiotherapy can be delivered across the tumour in:

• a single field (at one angle)
• multiple fields (at more than one angle)

The number of fields is relevant to derived fee items for services before 1 July 2024.

Dosimetry

A dose of radiation treatment is the total amount of treatment to be delivered to a tumour site over a period of time. The dosage to be absorbed by the patient is calculated and measured by a dosimeter prior to a treatment. Calculating and planning the dose is referred to as dosimetry.

Simulation

Determines the field settings used for treatment. Requires the use of specialised machinery (for example Isocentric X-ray machine, Computed Tomography (CT) scanner, megavoltage machine).

Fractionated treatment

When the total dose of radiation to be delivered is divided into small daily amounts over a period of weeks or months. This gives a cumulative effect to the tumour but allows normal surrounding tissue to repair.

Hyperfractionated treatment

Radiation therapy treatment delivered multiple times a day instead of in a once a day dose, for example treatment is delivered to the same tumour site once in the morning and once in the afternoon.

Kilovoltage

Use of radiation beams with an energy of 50 thousand to 500 thousand volts (50 kV to 500 kV). See items 15950 - 15956 for services from 1 July 2024.

Teletherapy

Treatment is from an external source, for example, cobalt.

Orthovoltage and megavoltage radiotherapy are a form of teletherapy.

Orthovoltage

Use of radiation beams with an energy less than one million electron volts (1 MeV).

Orthovoltage radiotherapy comprises both superficial and deep X-ray therapy.

For services before 1 July 2024, items 15100 - 15115 are for deep radiotherapy or orthovoltage.

Megavoltage

Use of radiation beams with an energy of or above one million electron volts (1 MeV). Deepest external ray used for deep structure, for example lung, prostrate, breast. Primary and secondary body sites are specified in these item numbers (before 1 July 2024 only).

See items relevant for the date of service:

• 15902 - 15948 for services from 1 July 2024
• 15211 - 15275 for services before 1 July 2024

Brachytherapy

Brachytherapy is a form of radiotherapy where a sealed radiation source is placed inside or next to the area needing treatment. Body sites are specified in the descriptions for these item numbers. Brachytherapy is commonly used for cervical, prostate, breast, and oesophageal and skin cancer. It can also be used to treat tumours in many other body sites.

See items relevant for the date of service:

• 15958 - 15984 for services from 1 July 2024
• 15303 - 15357 for services before 1 July 2024

Stereotactic radiosurgery

A non-surgical procedure that delivers precisely targeted radiation at much higher doses in only a single or few treatments as compared to traditional radiation therapy.

The stereotactic radiosurgery item 15600 includes all radiation oncology consultations, planning, simulation, dosimetry, and treatment.

This item is for services before 1 July 2024.

For services from 1 July 2024 stereotactic services attract Medicare benefits in items 15918 - 15922, 15942 and 15944.

Intraoperative radiotherapy

Radiotherapy treatment delivered at the same time as breast conserving surgery. See item 15900 for services before and from 1 July 2024.

External beam radiation therapy (EBRT)

Radiation therapy delivered at a distance from the body, most commonly by a linear accelerator. (Also called teletherapy.)

Intensity Modulated Radiation Therapy (IMRT)

IMRT is a form of EBRT that uses high energy megavoltage x rays to allow the radiation dose to conform more closely to the shape of a tumour by changing the intensity of the radiation beam.

Image Guided Radiation Therapy (IGRT)

IGRT, refers to the use of imaging, usually Computed Tomography (CT) scans and X-rays, to help precisely target the cancer with radiation therapy. Imaging is taken every date before each radiation treatment to ensure the cancer or region lines up exactly as planned. IGRT is always used when IMRT is being used.

Linear accelerators (LINAC)

Uses the energy of very fast electron streams to produce high-energy X-rays.

High energy LINACs give X-ray beams with energy of at least 10 million electron volts (10 MeV).

Many modern LINACs are dual-energy machines which produce high and lower energy X-rays, as well as electron beams.

Telecobalt ('cobalt') units

Uses a radioactive cobalt (Co 60) source to produce a gamma ray beam.

Unsealed radioisotopes

Mixes freely with the patient's body fluids (for example, radioiodine for thyroid cancer) and are mainly used in nuclear medicine.

Sealed radioisotopes

Used in surface moulds and in radioactive implants.

Surface moulds

Contain sealed radioisotopes and are applied to the patient's skin daily, usually for several weeks.

Radioactive implants

Used to administer either intracavitary or interstitial brachytherapy.

Radioactive implants are either preloaded or afterloading.

Afterloading radioactive implant

Filled with the radioisotope after it is inserted into the patient's body. The radioisotope may be put into the implant manually or automatically, using a computer system.

Preloaded radioactive implant

Already contains the radioactive material and thus exposes the operator to radiation.

Intracavitary brachytherapy

Insertion of a radioactive implant into a pre-existing body cavity, for example, the uterine cavity.

Interstitial radiotherapy

Insertion of a radioactive implant directly into body tissues containing cancer, for example, the tongue.