Overview of the Radiation Therapy Treatment Process
The following are the steps generally followed when a patient is preparing for radiation therapy. These may differ slightly depending on the protocol at your treatment facility or if your treatment is being done on an urgent basis, but many of the steps are the same across treatment facilities.
Whenever radiation therapy is being considered as part of your treatment plan, a consultation visit will be arranged for you with a radiation oncologist, a physician specially trained in using radiation therapy for treating your type of cancer.
The purpose of this visit is to discuss the role of radiation therapy in your treatment, to determine the type of radiation therapy to be used, the treatment plan for your treatment, and to answer any questions you may have.
Informed Consent Process
Physician will review in detail the proposed treatment, the reasons for recommending the treatment, and the potential risks and side effects of such treatment.
Ample time will be provided so that you have a full understanding of the treatment and related issues and have all of your questions and concerns answered in full.
We encourage you to bring family members or significant others with you, as they may be able to help you during the process and have their own questions answered.
Once you feel that you have a full understanding of the proposed treatment, risks, side effects and other possible treatment options, you will be asked to sign a consent form.
Before you sign the consent form, you need to make sure that you are comfortable with the explanation that you have received. Even after you have signed the consent, your physician is always available to answer new questions or to provide additional information.
Immobilization Devices and CT Simulation
Before radiation treatments begin, you will go through a treatment planning process called “simulation.” This process is where your radiation treatment team will precisely identify the area on your body where you will receive radiation.
Positioning is extremely important in radiation therapy and your body will be positioned carefully in order to get the best radiation treatment. You will be in the same position during every treatment, and you will need to remain still during the treatments.
Immobilization devices are made individually for each patient who needs one. These devices can be in the form of a mask that holds the head in position, or “vaclock” made out of a pack of granules product that hardens and is moulded to hold a particular body part in position. These assure that you are in the exact same position for every treatment.
A planning CT scan of the region to be treated is done.
The entire simulation takes approximately an hour, though the actual time may vary. Since you will be lying on a hard table under the simulator for most of this time, you may experience some pain or discomfort. If this occur, tell the radiation technologist.
Keep in mind that the time necessary to deliver the actual radiation therapy treatments is only minutes, not nearly as long as the time required for the simulation.
In certain cases, an MRI or a PET/CT scan will also be done the same day as the CT simulation. The information provided by these scans is also used to plan your treatment.
During the simulation, it is necessary to put marks on your skin to outline the treatment field(s). These marks are very small, which are dots/lines, made using permanent ink marker.
The process of marking may not cause any discomfort. Generally, between 4 and 8 marks are placed and covered by tegaderm, but sometimes more or less are necessary.
The tegaderm are necessary to make it possible for you to bathe or shower on a daily basis so not to remove these important marks.
After these CT-simulation and marking procedure, patient can go home and can come on treatment appointment given day.
Technical Planning Process
After simulation, the CT images details from the procedure are forwarded to planning workstation.
Radiation oncologist contour the tumour and critical structures.
Medical physicists perform highly technical calculations that will be used to set the treatment machine (linear accelerator). The physicist work closely with your radiation oncologist to develop the treatment plan, a process that can take up to few days or a week.
Several days after the simulation and after all calculations have been performed, your treatment can begin.
The treatment machines (linear accelerators) resemble the simulator, but are larger.
You will be placed on the treatment table in the same position as you were on the simulator. Proper positioning usually takes 10 to 15 minutes.
Once in place on the treatment table, a set of X-ray images will be taken. These images will be matched with the simulation images to ensure that the treatment is going to be delivered the same way as it was simulated.
Once the images and positioning are confirmed, treatment will be delivered.
While it seems like a lot of time to plan and set up, it is critical that the treatment be given as it was planned to avoid unnecessary toxicity to healthy tissue and to get the correct radiation dose to the treatment area.
The actual administration of the radiation treatment typically takes about 5 to 10 minutes.
Once the initial set-up is completed, daily treatments normally follow. Treatments are usually given once a day, Monday through Friday, for a number of weeks.
Each treatment generally takes only 5 to 10 minutes; however, you will likely be in the department for an hour each day.
Each day, the technologist will position you on the treatment table, using the markers on your skin, immobilization devices and laser beams on the machine to get you in the exact same position.
Once you are set up for treatment each day, the radiation technologist will leave the treatment room to avoid exposing them to radiation.
They will be able to see and hear you from a control room just outside the treatment room. They can also give you instructions over a microphone as needed during the treatment.
As you lie on the treatment table, the table and linear accelerator may move to get the radiation beams in the correct location. Once your position is confirmed, the treatment is given. The treatment is not painful, nor will you feel anything when the treatment occurs.
Daily and/or twice a week, repeat X-ray images will be taken to re-confirm proper positioning.
Your radiation oncologist will examine you at least once a week. The examination will take place just before or after your treatment is administered. These examinations are important because they give your physician and nurse the opportunity to evaluate your physical condition, answer any questions that you may have, and plan and coordinate future treatments.
If you are having a problem, you should not wait until your next on-treatment examination. Instead, you should ask to be seen or call the department. Your nurse will review your problem or concern and if he/she cannot help, will contact your physician.
Once your radiation treatments have been completed, or a day or two before your last treatment, you will have a final visit with your physician. During this visit, your doctor will perform an examination and discuss follow-up care.
After the completion of radiation therapy, we will follow your progress and see you on a regular basis. We understand that you may be seeing many other physicians, but it is important for us to participate in this follow-up process so that any radiation-related problems can be identified early and treated. We will also stay in touch with your other cancer specialists.
The consultation will take one or more hours, depending on your particular situation. Please bring with you all X-rays, CT Scans, MRIs, laboratory studies, pathology slides, operative reports and other tests that have been performed so that they can be reviewed by the radiation oncologist