The purpose of this section is to provide you with an overview of the radiation therapy treatment process, from the initial consultation through treatment and follow-up. We encourage you to read through all of this information, or, if you prefer, you can go directly to specific sections by simply clicking on that title below. We hope you find the information helpful, and that it enhances your understanding of your care.
The following information is contained in this section:
- Initial Consultation
- Informed Consent process
- Treatment Planning
- Technical Planning Process
- Daily Treatments
- Treatment Times and Scheduling
- On-Treatment Examinations
- End-of-Treatment Visit
- Follow-Up Care
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 confirm the use of radiation therapy in your treatment, to determine the kind of radiation therapy plan to be used for your treatment, and to answer any questions you may have. The consultation will take from one to several hours, depending on your particular situation. Please bring with you all X-rays, laboratory studies, pathology slides and other tests that have been performed so that they can be reviewed by the radiation oncologist.
During the visit, a detailed history and physical examination will be performed by your physician. Your physician will also discuss their findings with other members of the multidisciplinary treatment team so that all treatments, such as surgery and chemotherapy, will be coordinated to ensure that you can receive the best possible care. At the end of the visit, your physician will review and recommend the role of radiation therapy in your care. If radiation therapy is not recommended, the physician will also discuss the reasons for this.
Informed Consent Process
If radiation therapy is recommended as a part of your treatment, your 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. You can withdrawal your consent at any time for any reason.
For additional information about the consent process, go to OncoLink: Making Treatment Decisions - Informed Consent.
Before radiation treatments begin, you will go through a treatment planning process called "simulation" to confirm that the treatment machine will treat the exact location on your body. A map of the area on your body where the radiation is to be delivered, referred to as the treatment field(s), is created. A machine called a simulator, which is designed to mimic the movements and settings on the actual treatment machine (called a linear accelerator) that will be used to administer the radiation therapy to you, is used.
Throughout the process, X-ray films will be taken. The entire simulation takes approximately an hour, but, the actual time may vary slightly. Since you will be lying on a hard table under the simulator for most of this time, you may experience some pain or discomfort. Should this occur, tell the technician. 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 some situations, a special computerized tomographic (CT) scanner will be used along with simulation to help plan some radiation therapy treatments. In these instances, the CT scanning process will be performed in the Radiation Oncology Department several days prior to the simulation. Information from the CT scan is used to precisely locate the treatment fields. The CT scanner is specially designed to work with the other equipment in the Department, and is not a replacement for other diagnostic scans you may have received.
At the end of the simulation visit, it is necessary to put marks on you to outline the treatment field(s). These marks are in the form of very small tattoos, which are dots the size of a pinpoint or freckle, made using India ink. The process of tattooing causes some temporary discomfort. Generally, between 4 and 8 tattoo marks are placed, but sometimes more or less are necessary. In some treatment plans, a second set of tattoos may be necessary. While the tattoos are permanent, because of their very small size, they are not very noticeable. By using the tattoos, it will be possible for you to bathe or shower on a daily basis without worrying about removing these important marks that show where the radiation treatments are to be delivered. Also, if any additional radiation therapy is needed in the future, the tattoos serve as a permanent record of previous treatments. In very rare instances, tattoos will not be used.
Technical Planning Process
After simulation, details from the procedure are forwarded to medical radiation dosimetrists and medical physicists. These professionals perform highly technical calculations that will be used to set the treatment machine (linear accelerator).
Large alloy blocks may be placed inside the treatment machine to limit the amount of radiation delivered to your normal tissue in the treatment field. These blocks help decrease the development and/or severity of side effects caused by the treatments. Blocks are customized for each patient, in order to provide the best protection.
Several days after the simulation and after all calculations have been performed and custom blocks made, your treatment can begin.
Our 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 films will be taken. These films will be matched with the simulation films to ensure that the treatment is going to be delivered the same way as it was simulated. Occasionally, the match is not optimal. In these cases, adjustments will be made and will be checked by your attending physician. In rare cases, more adjustments are required and treatment may need to be postponed. Once the films and positioning are confirmed, a treatment will be delivered.
The actual administration of the radiation treatment usually takes only about 5 to 10 minutes. Factors that affect the total length of the treatment include the complexity of your treatment, the particular machine on which you are being treated and how quickly you can be positioned properly for treatment. On average, most patients spend a total of 20 to 30 minutes in the Department per day receiving their treatment.
Often, your attending physician will be called to see you at the machine to make sure that your position is correct. This should not cause you any concern as it is a standard part of our practice to ensure the most accurate delivery of the radiation treatments.
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 our department for approximately 20 to 30 minutes per day. Sometimes, twice daily radiation treatments will be recommended.
Treatment Times and Scheduling
Treatments take place between 8:00 AM and 4:30 PM, Monday through Friday. Scheduling of treatments is fairly flexible and every attempt will be made to accommodate your schedule within a reasonable period of time. In most cases, your treatment will be scheduled for the same time each day for the entire course of treatment.
Once a week, repeat X-ray films will be taken to re-confirm proper positioning. These films will also be performed in most cases where there is a change in your treatment field or treatment plan. The X-rays taken during the course of radiation treatment are not used to help measure your progress or response to the radiation. Rather, they are only used to ensure that the position and treatment arrangement is appropriate.
You will also be examined at least once a week by your attending physician and resident. The examination day is generally on Thursday, just before or after your treatment is administered. These examinations are important because they give your physician 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. If indicated, you will be seen by your attending physician. If there are any problems at night or on weekends, call the hospital page operator and ask for "the radiation oncologist-on-call."
Once your radiation treatments have been completed, you will have a final visit with your physician. This will occur just after your last treatment has been administered. During this visit, your doctor will perform an examination and discuss follow-up care.
In general, follow-up appointments occur between 2 and 6 weeks after the completion of radiation therapy. After that, 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.
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