Consultation
Your consultation is your first visit with the radiation oncologist. During this visit, your radiation oncologist will review all your records and pathology reports and give you a physical exam. It is important to bring a list of all your medications to your consultation. Include all prescription medications, vitamins, supplements, and any over-the-counter medications that you take. Please write down the dose of each medicine, how often you take it and when you take it. Make sure you tell your nurse or doctor if you have any allergies or if you are pregnant. This visit will be an opportunity for the treatment team to help you understand your diagnosis and the treatments available to help you. During this visit, your doctor and nurse will go over information about your type of cancer, radiation treatment choices, and any possible side effects. The doctor will also explain your treatment plan, which includes:
- Why the treatment plan is best for you
- What it can and cannot do
- The type and amount of radiation therapy you will receive
- How the radiation team will perform your treatment
- What the side effects of the treatment might be
- Planning Your Treatment – Simulation
Your radiation oncologist will develop your plan through a process called treatment planning. This first step in this process is called “simulation.”
The simulation includes a CT scan of the specific area where the tumor is located. With the help of this scan, your radiation doctor will map out the exact location of your tumor and the area that needs treatment.
During the simulation, you will be placed in a position that is most effective for the area of the body being treated. A radiation therapist will construct necessary positioning devices, such as molds and masks, that will help maintain your exact positioning throughout the course of your treatment. It is necessary to ensure that your position during simulation and treatment is exactly the same every day relative to the machine delivering the treatment and the machine performing the imaging. You will also receive temporary skin marks during the first simulation. These marks correspond with a specially calibrated laser alignment system, and they help your therapist replicate your position during the second simulation. Your radiation therapist will place a protective covering over these marks, as you will need to keep the marks on your skin until your second simulation.
During the second simulation, you will be repositioned according to the parameters established during the first simulation. A coordinate system will be marked out on your skin that corresponds with the target that your doctor defined during the first simulation. You will also have a CT scan to verify the accuracy of the final coordinates on your skin. You will then receive tattoos (tiny ink dots placed under the skin) to help line up the treatment area. These tattoos are very important because they allow the radiation therapist to position you the same way for each treatment. Once the simulation is complete, you will schedule your first visit to the radiation treatment machine.
Some treatment techniques will require you to have a “dry run” of your treatment. During this session, the radiation therapists will take you into the treatment room and position you according to your tattoos and treatment parameters defined in the planning process. They will then take a series of verification X-rays using the treatment machine. No treatment is delivered during this session. Your radiation doctor will then review all the verification X-rays before your first treatment to ensure they match the planned treatment.
Your Treatment Schedule
The amount of radiation and the number of treatments needed are different for each patient. At the beginning of your therapy, your radiation doctor will give you an estimate of the number of treatments you will need. Sometimes your doctor will adjust the number of treatments you need as treatment proceeds.
External beam radiation is typically given in small doses over a period of time, ranging from one day to several weeks. This gives healthy cells a chance to recover and repair. Radiation treatments are given daily, five days a week, Monday-Friday. The radiation therapist will work with you to arrange your treatment schedule. It is very important that you keep all your appointments. If you are not feeling well, or if there are severe weather problems, please call us.
The Treatment Process
Family or friends may come with you and wait in the front waiting room while you receive your treatment. No one will be allowed in the treatment session.
When you come for your first radiation treatment, you will be escorted into the treatment room by your radiation therapists. In the treatment room, the radiation therapists will check and recheck all of the equipment settings to make sure it follows your treatment plan precisely. The therapists will then use the tattoo marks to locate your treatment area and place you in the correct treatment position using the positioning devices designed for you during the simulation.
Before starting some treatments, the therapists may take a set of verification X-rays. These X-rays ensure that the treatment plan is accurate before the treatment begins.
The radiation therapists will leave the room before the treatment begins and will watch you constantly on a television monitor. Using an intercom, the therapist can hear and talk with you throughout your radiation treatment.
Remember, your radiation treatments are painless. During your radiation therapy, you should hold still but can breathe normally. You will hear noises coming from the machine and see the machine move around you, but you will not feel anything.
As soon as the treatment is over, you may leave and return to your normal activities.
Checking your Treatment Progress
Once a week during the course of your treatment, you will stay after your treatment to visit with your radiation doctor. During this visit, your doctor may:
- Give you a physical exam
- Review your blood work
- Review your verification X-rays
- Make changes in your treatment plan
- Prescribe medications
These appointments are an excellent time to ask your doctor and nurse questions and discuss any problems or concerns you may have. You may find it helpful to write a list of questions ahead of time. You are also allowed to bring friends or family members into the exam room with you.
After Your Treatment Program Ends
You will have regular follow-up appointments scheduled with your doctor to monitor your progress. This first follow-up appointment with radiation oncology is typically scheduled for six weeks following the completion of your treatment course. It is essential that you keep these appointments. The effects of radiation may continue for several weeks to months after the completion of your treatment, and it is important to notify both your referring physician and your radiation doctor if any symptoms or concerns develop after your treatment ends.