What to Expect During Your Course of Radiation Therapy

CT Simulation:

The CT simulation is the procedure during which we plan the radiation treatment on the CAT scanner. The area(s) of your body to be treated are established and may be outlined directly on your skin with a marker.

We begin by putting you in a comfortable and stable position so that you will be able to remain as still as possible during the CT simulation. The goal is to position you the same way as you will later be positioned during your treatments. Laser beams are used to position your body precisely and establish the exact center of the area to be scanned (and later treated). Crucial areas, such as the very center of the field, will be marked with very tiny tattoos. We may need to use permanent ‘tattoos’ to assist us in positioning you for treatment, and this will be discussed with you.

For treatments near the head, a mask may be used, and the marks will then be put on the mask. A device called a Vak-Fix bag may be used when the area to be treated is in the upper body. The Vak-Fix looks like a beanbag; however, we evacuate the air from it so that it will conform to your body and stay the same shape throughout your treatment.

Later in your treatment there may be a need for a second simulation in order to plan the next stage of your radiation treatment or to make any changes the radiation oncologist deems necessary.

Treatment Planning:

Between the time of your CT simulation and the time of your first treatment, the dosimetrist and the radiation oncologist will plan your treatment using a very sophisticated computer. Information from the CT simulation and any other techniques, such as MRI or PET scans, will be used to determine the most effective and safest treatment for you. This is why there is sometimes a delay between the CT simulation and your first day of treatment. The precise number of treatments is determined during this procedure. However, depending on the needs of each individual person, the planned number of treatments occasionally needs to be slightly modified during treatment.

Treatments:

The actual daily treatments generally only require 15-20 minutes in our office. The actual duration of radiation that you are exposed to is generally seconds to minutes. Most treatment courses occur daily, and last approximately 6-7 weeks, although the amount of time will be tailored by the radiation oncologist to optimize the treatment for your specific problem. Some may be as short as 1-2 weeks. The doctor will answer any questions regarding the length of your treatment course at any time during your treatment.

The machine used to give your treatments is called a Linear Accelerator. It is the most modern machine available for what are called external beam radiation therapy, Intensity Modulated Radiation Therapy (IMRT), and Image Guided Radiation Therapy (IGRT) treatments. Our linear accelerator has many different energies and two types of radiation. These different radiation beams are selected based upon which area of your body we are treating. We will choose the type which will be optimal for your treatment. Radiation therapists will give you your treatments. For each treatment you will be precisely positioned using laser beams, the mask or Vak-Fix bag (positioning devices), and often a technique called Image Guidance (IGRT). Depending on your plan of treatment, you may have had ‘markers’ inserted into the treatment area to facilitate image guidance, and we will take a scan of you prior to treatment to verify that you are positioned optimally. All though we try to make you as comfortable as possible, the table of the linear accelerator is designed to position you such that your movements are minimized and limited, thus assuring that the radiation is only hitting the designated target areas.

The gantry of the linear accelerator contains a devise called ‘multi leaf collimator’, which will adjust the portal through which the radiation beam travels to create what is called a ‘field’, or area of treatment. The gantry will rotate around the treatment table so that you can receive treatment from several different angles. There is an audio system as well as a visual monitor so that we can hear and watch you during your treatment. Everything must be accurately set in order for the linear accelerator to operate, and the treatment will not occur until you are positioned exactly as you should be, and the settings on linear accelerator are recorded and verified. The treatment itself is usually very brief.

The radiation therapists can answer many of your questions about the treatment process. They will also assist you by scheduling your treatment appointments at a time during the day that is convenient for you.

Devices Used for Radiation Treatment:

There are many services performed prior to your first treatment in the office. These services may be utilized for treatment planning, beam shaping, patient immobilization, and shielding of your critical organs. You may see charges on your statements for ‘treatment devices’ or procedures on days you were not seen in our office. These are usually developed prior to your first treatment to insure accurate and safe radiation delivery, and must be billed on the date that the service was performed. This is in accordance with federal and local guidelines for radiation therapy billing practices.

Side Effects:

Experiencing side effects during or after radiotherapy are an unavoidable possibility of this very effective therapy. However, the combination of careful planning, precise delivery of therapy, and good communication between you and the radiation oncology team will greatly diminish the development and severity of these problems and help us manage them should they occur.

We want to help you understand and manage these side effects. The doctor and nurse will discuss expected and possible side effects with you before beginning therapy.

External radiation therapy does not cause your body to become radioactive. There is no need to avoid being with other people or having physical contact with them because of your treatments. Side effects of radiation therapy are most often related to the area being treated. For example, if your upper abdomen is being treated, you may have some nausea, but your treatments will not cause headaches, sore throat, or hair loss. Many of these side effects are temporary.

The side effects often may not occur until you have received 2 to 4 weeks of treatments. You will have plenty of time to get acquainted with the staff and the treatment routine before your side effects appear. We welcome your feedback and questions about any side effects; always feel free to ask questions. Let us know of any concerns you may have or if you think you may be experiencing any side effects which we may not have discussed.

Review Day:

We understand every patient is different and unique. That is why your time with your physician is important for reviewing your course of treatment. The radiation oncologist and nurse will meet with you regularly during your treatment course. These visits are a minimum of once each week, and more frequently if necessary.