What to Expect
The first step is a consultation with a radiation oncologist who works closely with other physicians and medical professionals to coordinate the best possible care for every patient. This appointment generally takes an hour to an hour and a half.
Upon arrival, patients are met by a nurse who will bring them to an exam room, ask for a list of current medications, and collect a brief medical history. During a meeting with his or her radiation oncologist, the patient will answer additional questions; have his or her medical records, x-rays, and test results reviewed; and undergo a physical exam. Afterwards, the radiation oncologist will discuss treatment options with the patient in detail and explain radiation treatment and its potential side effects. If additional testing is necessary, it will be arranged.
Patients are encouraged to bring a family member or loved one with them to their consultation appointment. They are encouraged to ask questions and voice concerns. It's a good idea to bring a list of questions to this visit.
Before the consultation is over, the patient will be scheduled for his or her treatment planning session (also known as simulation) and will be given additional information and instructions to take home.
After the consultation, the patient returns for a treatment planning session, also known as simulation. This appointment takes about an hour to an hour and a half. If there are any instructions the patient needs to follow prior to coming to this appointment, they will have been given to him or her at the initial consultation.
During simulation, the physician and radiation therapist work together to plan the patient’s treatment. Many simulations are performed using the department’s CT scanner. The therapist will position the patient on the treatment table and create custom immobilization devices specific to his or her body and treatment site. This is done to help the patient maintain the exact same position throughout each daily treatment. It is essential that radiation treatments be precisely targeted. Therefore, it is important that the patient remains as still as possible during treatment.
Marks may be drawn on the patient’s skin to outline the treatment area, and small permanent tattoos, the size of a freckle, will be placed under the patient’s skin as reference points for the therapists to use during each daily treatment.
Additionally, x-rays, CT scans, MRIs, PET/CT scans, or other state-of-the-art imaging technologies will be taken to assist in planning the course of treatment. These scans are different from the diagnostic scans the patient may have had previously because these will be performed in the treatment position.
After simulation is completed, the information is sent to special computerized treatment planning software, whereby the physicists and dosimetrists will work with the patient’s radiation oncologist to formulate and design a personalized treatment plan for the patient. This complex planning process usually takes one to two weeks. Before the patient leaves, he or she will be given his or her treatment appointments and any special instructions.
Typically, the first treatment will take a little longer than the regular daily treatments and will be used to take x-rays to verify that what was planned during simulation is reproduced exactly. The patient will meet the radiation therapists who will be treating him or her through the course of his or her daily treatments, and a radiation oncologist may come to the treatment room to check the setup and make minor adjustments if necessary. Usually, only 20 to 30 minutes are needed on this day.
Once a week during the patient’s treatment course, he or she will be seen by his or her radiation oncologist. These "on-treatment visits" usually fall on the same day each week, following the day’s treatment. Patients should plan to be in the department longer on these days.
If, at any time during treatment, the patient has a question or concern, he or she should not hesitate to voice it. Nurses are always available and will help determine if the patient needs to see a radiation oncologist.
During the course of treatment, patients may experience side effects from the radiation. Possible associated side effects are discussed in the Frequently Asked Questions section. Patients should bring any side effects to the attention of their nurse or radiation oncologist, so they can monitor them and provide specific instructions.
When treatment concludes, the radiation oncologist will continue to follow up closely with the patient. Depending on the physician and the treatment site, patients will be seen two weeks to one month following treatment, so their radiation oncologist can continue to monitor any side effects the patient may have experienced.
For many months, patients may continue to experience subtle changes as a result of their treatment. Therefore, it is very important to continue with follow-up appointments. Future follow-up visits will be scheduled every three to six months, so the radiation oncologist can continue to monitor the patient’s health. Routine scans may be ordered prior to an appointment.
Additionally, the patient’s radiation oncologist will continue to work with the patient’s medical oncologist and/or primary care physician to ensure good health is maintained.