The process of radiation therapy will be customized for patients, depending on which form of radiation therapy patients and their physicians choose as their options. Overall, there are five basic steps of radiation therapy that we can share to give patients an idea of what to expect. These steps include initial consultation, simulation, treatment planning, treatment delivery and post treatment follow-up.
Consultation is the first step of the radiation therapy process. This involves an appointment with a radiation oncologist, who reviews a patient’s medical records, pathology reports and radiology images and performs a physical examination. If, based on this review, treatment by radiation therapy is chosen, the patient will be offered an appointment for simulation.
Following your initial consultation, you will undergo a “simulation” process. The simulation allows the radiation oncologist to define the exact location and configuration of the treatment for your cancer or tumor. In order to accomplish this, x-rays or CT scans will be taken in the radiation oncology department. Sometimes contrast is used to improve the quality of the information. For example, you may be asked to swallow a contrast agent or you may be injected with one, similar to when you have a diagnostic CT scan performed. You will be placed in the treatment position, and often there will be customized “immobilization” devices such as mesh masks, headrests, or form-fit body molds to maintain your body position the same on a day to day basis. Sometimes, the area on your body that requires treatment will be marked with a tiny tattoo “dot”. This will help with the treatment set and ensure that the radiation is directed properly each day. These marks should not be removed or washed away. Staff will discuss with patients how to protect the marks so they remain in place.
This step of the radiation process involves the radiation oncologist, the physicist and dosimetrist. Using the CT scan images (and a MRI or PET, if needed), they work together to design the field of radiation therapy treatment. The focus of treatment planning is to deliver a high dose of radiation to the tumor while limiting the dose received by surrounding tissue that is normal. This helps preserve normal tissue and reduces side effects of treatment. Treatment plans are customized for each patient and become the blueprint for treatment delivery. Developing the treatment plan may be a complex process aided by the use of computers that recreate your “virtual anatomy” and location of your cancer or tumor. It may take several days to complete the treatment planning process.
On the first day of treatment, the patient is placed in the position for treatment using immobilization devices that might be necessary for them. Radiation therapists are responsible for positioning the patient and for delivering the radiation dose prescribed by the radiation oncologist. Images are taken on the first day of treatment and at regular intervals, if necessary. These images confirm that the area of the body being treated has not changed position. Radiation therapists view the patient from monitors adjacent to the treatment room and can talk with the patient via intercom. Individual treatment sessions typically do not last long; often, the patient will be in the treatment room for no more than 20 minutes, and much of this time is used for accurate positioning. After your treatment, the technologists will help you get off the table and bring you to a patient exam room, when necessary. At this time, you will meet with the radiation oncology nurse to discuss issues related to radiation, including skin care and nutrition during treatment.
Over the course of radiation therapy, you will meet with your doctor at least once a week as well as the other members of the treatment team, including nurses. In addition, should you have concerns or symptoms that need to be addressed, you may meet with any of your treatment team members on any day at your request.
Post Treatment Follow-up
Upon completion of your treatment, a follow-up appointment will be scheduled to monitor the recovery and overall health of our patients. Additional diagnostic tests may be ordered. Reports on the status of our patients are sent to all physicians involved in patient care. As time goes by, the frequency of visits to the Department of Radiation Oncology will decrease, but physicians and other providers are always available to talk with patients and address any questions and concerns they may have.