The Sequence of Radiation Therapy

First, the patient is referred to our Radiation Oncology office as an outpatient which allows the patient to receive treatment and hen return home the same day. A series of appointments are setup for the patient and are scheduled to be completed over several days. These appointment will include visits for consultation, planning, film check, and treatment. 

Visit one: Consultation

A radiation oncologist will examine the patient and review the patient's medical chart, x-rays, and laboratory tests. The doctor would then make a decision about whether the patient should receive radiation therapy and, if so, what type. Once the need for radiation therapy has been established, the doctor will discuss the benefits of treatment and any possible side effects that might occur.

Visit two: Planning

This appointment, sometimes called a planning session or simulation, prepares the patient for the radiation treatment. The session ranges from 30 minutes to two hours and at this time special planning to pinpoint the treatment area is conducted. The patient will be asked to lie very still on a flat table while the radiation therapist, under the supervision of the radiation oncologist, uses a special CT Scanner or x-ray machine to define the patient’s treatment area, sometimes called the treatment portal or field. Alignment is critical during this process, so the patient must be completely still on the table. Once the field is determined, this is the exact spot on the body where the radiation will be aimed. Ink lines are drawn on the skin to identify the area to be treated. Tattoos (tiny permanent skin markings the size of a freckle) may be placed at the time of simulation. This will be the longest appointment the patient will experience during the course of treatment. 

Several other treatment planning steps occur after simulation and before treatment, but the patient is not required to be present for these. With the aid of the CT scanner three dimensional volume of the target area is created on highly sophisticated computers. These computers help customize special devices (blocks) to shape the radiation field for better accuracy and to protect healthy tissues from the unneeded side-effects of radiation beam. Specialized simulation x-ray machines may also be used for this process. 

The information from simulation, other tests, and the patient’s medical background will be used by the doctor, radiation physicist (who monitors the equipment), and dosimetrist (who calculates the correct dose) to create a customized treatment plan. The physicist and the medical doctor double and triple check all calculations. The doctor then decides how much radiation is needed, how it will be delivered, and how many treatments the patient will need. After all treatment planning is completed, the patient returns for verification on the treatment machine. X-rays will be taken to ensure that the proper position for your treatment has been achieved. All x-rays, films, and dose calculations will be reviewed and confirmed. Once the information indicates that the set-up for treatment is satisfactory, actual treatment will begin on the patient's next visit. The radiation oncology staff will provide the patient with written instructions about how to care for the treated area.

Visit three: Treatment

Treatments are generally administered on an out patient basis and are five minutes or less. However, the total appointment is approximately half an hour which allows time for dressing and undressing. 

A radiation therapist, licensed by the state, will administer the patients daily treatments, under the supervision and exact prescription of the medical doctor. The patient lies on the treatment table and is carefully positioned for treatment. The patient must remain in this exact position while receiving treatment. Once started, the patient will be alone in the treatment room while the therapist observes a video screen and may speak with you over the intercom. There is no pain associated with radiation therapy. 

After the machine shuts off, the patient should stay in the treating position until the therapist returns to the room to assist with dismounting the table. A specialized computer (record and verify system) is used to verify the accuracy of the radiation treatments and dosage to the exact specification as was prescribed by the medical doctor. This computerized system will not allow the radiation machine to turn on if any dose other than what was prescribed by the medical doctor is dialed in to the machine. This system nearly eliminates the possibility of human error in patients treatment. 

Please remember that treatment is given promptly at the time scheduled. Each treatment will be at the same time each visit.

Physician Follow-up Visits During Therapy

A physician will see you nearly every five treatment days to check your progress. Blood tests may be taken to check the effect of radiation on your red and white blood cells. If your red or white blood cell counts get too low, you may have to stop treatment until these counts increases. In some patients a base-line blood test prior to start of radiation may be adequate. 

X-rays may be taken regularly to verify the correct positioning of the patient. The radiation oncologist is available everyday of your treatment should you have a specific question or concern.

Side Effects

Due to the high doses of radiation needed to destroy the cancer cells, some normal cells will be hurt, thus causing side effects. These will vary depending on the area treated and the dosage received. The patient may tire easily because the body is using a lot of energy to fight the cancer, get rid of unhealthy cells, and rebuild injured healthy cells. Once fatigue is experienced, the patient should rest as much as possible. It is also very important to eat properly during your entire treatment to maintain your weight and strength.

A Positive Attitude Is The Key To Success In Radiation

It is also very important for the patient, as well as his friends, family to be aware that the patient may feel differently during the course of treatment. Some people report emotional changes in response to their medical condition and or starting treatments. Keeping a positive mental and emotional approach to your treatments and to combating cancer itself is very important to your successful recovery. A licensed clinical social worker is available to talk with you, your spouse, or any family member. To request counseling, simply ask to speak with the radiation oncology social worker.