Here are some images that were made before I had RT last spring. I'm posting this because I think the images might be interesting to some readers of this forum.

First planning event:

I started by seeing a hand surgeon. I asked him to palpate my hand and mark a boundary for the affected area. He had never done this before, but when I showed him a picture of a hand that was marked up by Prof. S, he got the idea, and here's what he did:

As you can see, I took a photo, which I then showed to the radiation oncologist.

Second planning event:

I saw the radiation oncologist who had never before treated DD. I showed him medical journal articles from the two German groups and the photo above of my hand marked by the hand surgeon. The oncologist then arranged for both CT and MRI images of my hand. I understand that these costly images are not required for treatment for example by Prof. S, but it's customary for the cancer patients that my oncologist sees. They call it "image guided radiation therapy". The MRI images were used to prepare the plan, which you see below (try clicking the image to make it bigger):



I'll try to explain the three panels in this image:

Left panel: This is a cross section of my hand somewhere in the main part of the hand (not in the fingers). You can see four bones in cross section at the bottom. The palm is on the top of the image. During treatment, radiation will come from the top, generally along the direction of the three straight lines. The colored contours are part of the planning for the treatment: The orange contour shows the portion of my hand that will receive a 3 Gray dose, while the blue contour shows the portion that will get a 2 Gray dose. Note that the bones will get just less than 2 Grays dose.

Middle panel: This is a cross section on a plane that is 90 degrees rotated as compared to the left image. I think that the palm of my hand is on the left side and one of my fingers (probably my pinky, which is 22 degrees contracted) is in the upper 1/3 of the image. The plan is for the radiation to come from the left. Again you can see the colored contours showing where the 3 Gy and 2 Gy dosage will be. One of the purposes of this image was to plan the bolus -- the bolus (which is a jelly-like slab of soft material) had a thickness of something like 5 or 10 mm (I don't remember now), and its purpose was to reduce the dosage in the bones and healthy tissue that we don't really want to treat.

Right panel: This image shows the surface of my hand along with a dark-shaded region which will be the "radiation field."

Wow that is Great John,

Who is your oncologist?

Lanud, I don't know the energy of the electrons that were used. It didn't see it displayed on the monitor that I could see in the treatment room. I should have asked, especially since I'm a scientist and it would interest me, but I didn't.

Jolene, the physicians were both professors at the University of Iowa Hospitals and Clinics. Both the hand surgeon and the radiation oncologist. (I won't post names on a public forum since I have no permission). Several posters on this forum have found someone to do radiation treatment the same way I did -- just look for the name of a department head for radiation oncology at a major university hospital.

Callie, I agree, while the imaging is interesting it should be unnecessary. For tumors somewhere deep in the abdomen it would be different -- you would want to know exactly where the tumor is and what's around it, and the imaging would let you program the optimal treatment. Dupuytren's on the other hand is pretty much always right under the skin (so it's probably close enough to the same depth for every patient) and you can feel the nodules and cords (so imaging isn't needed to define the boundaries of the treatment "field"). So in all three directions, depth as well as lateral, there's no need for the imaging to figure out what to do for the treatment, if the treating physician is experienced with Dupuytren's. Mine wasn't.

So why did they image my hand? I think it was because they do it that way for the cancer patients and it's what they're used to doing. The sign over the clinic says "Image-Guided Radiation Therapy" -- so that defines what they do. They use the images on a computer to program the treatment by drawing the boundaries of the treatment field. It doesn't have to be that way, and it's more costly, but that's how they did it.