RADIATION THERAPY PROCESS (The road to recovery)
Step One - Referral/Consultation
You have been referred to Northern Indiana Oncology Center for a consultation. During your consultation, you and your family will meet with the radiation oncologist, a physician who is specially trained in radiation therapy. You, your family and the radiation oncologist will discuss the possible benefits of Radiation Therapy. The consultation consists of the radiation oncologist reviewing your current and past medical history and reviewing any imaging test such as CT, MRI, or PET scans you may have had. The physician may also perform a physical exam during your consultation to assess your current condition. During the consult, the physician will discuss all the benefits and risks of the radiation therapy. If, after your consultation, it is determined radiation therapy is the best course of action, the radiation therapy team will schedule a treatment planning CT and will start developing your radiation treatment plan.
Step Two - CT Simulation/Treatment planning CT
To determine exactly where the radiation will be directed you will have to undergo a treatment planning CT or CT simulation. You may be scheduled for your simulation at Porter Hospital or at the Valparaiso Outpatient Center. The CT scanner used during simulation is exactly the same scanner used for diagnostic CT scans and the room looks like any ordinary CT room.
A radiation therapist will be present at the time of your simulation to align and position you in a stable, comfortable, reproducible setup that will be duplicated exactly the same during your course of radiation therapy. You may be asked to change into a gown or partially undress so the radiation therapist can draw marks on your body in the area to be treated without having to alter your position to remove clothing. At the start of your simulation, after you have changed, the therapist will follow specific instructions set by the radiation oncologist. You may need to have an IV inserted for contrast dye, a rectal or vaginal marker placed, or wire taped to your skin to highlight scars, or predetermined field borders. Once this has been done, to achieve a desired treatment position, the radiation therapist may need to use immobilization devices to help keep your body still for the simulation and treatments. Immobilization devices can vary from a simple headrest or angle sponge to a more complex body mold or custom head and neck mask. After everything needed is in place, and you are properly positioned, the therapist will then use red positioning lasers to help align and mark the area to be treated by using a sharpie marker and small BB stickers. At this time, you are ready for the scan and you will be asked to breathe normally and hold very still until the scan is over. As soon as the scan is complete, the therapist will remove any markers or IV. The therapist will then ask permission to give permanent tiny tattoos (about the size of a pencil dot) on your skin to help us reproduce your exact position for the radiation treatments. Lastly, the therapist will have you sign a consent form to allow Northern Indiana Oncology Center permission to treat you with radiation as well as inform you of possible side effects you may experience throughout your treatment. The entire simulation procedure will last 30 to 45 minutes.
Step Three - Treatment Planning
After you have completed your CT simulation, the radiation oncology team will begin development on your custom radiation treatment plan. The radiation oncology team working on the treatment plan will consist of the radiation oncologist, medical physicist and medical dosimetrist. This planning process can vary in time ranging from one to seven days depending on the complexity and type of plan generated. The treatment planning CT will be sent directly to our sophisticated planning system moments after the scan is complete. The computer planning system allows for a three-dimensional plan to be generated with the option to fuse PET/MRI exams to help with the localization and mapping. The team will then determine exact location and field size to be treated as well as shape the beam to conform to the tumor. Other aspects are also determined such as how much dose will be delivered to the tumor and surrounding areas as well as deciding the type of beam, energy, and treatment angles to be used for your treatment. The number of treatments you will need is determined by the radiation oncologist and can range between two to eight weeks depending on the goal of the radiation treatments and area of the body to be treated. The radiation treatments are performed daily, five days a week Monday - Friday with weekends and holidays off.
Step Four - Scheduling a Radiation Treatment time
Once the treatment plan is complete, a radiation therapist will be contacting you to arrange a treatment time. NIOC hours of operation are 7:30 a.m. to 5:00 p.m. Monday thru Friday. Weekends and holidays are off unless there is an emergency. Radiation treatments are scheduled every 15 minutes and you will be asked to keep your appointment time throughout the course of treatment. If you desire a morning or afternoon appointment please let the therapist know and they will try their best to accommodate you depending on schedule availability.
Step Five - Pre-Radiation Treatment
Once you arrive at Northern Indiana Oncology Center at your scheduled appointment time, sign in and wait until a therapist calls you back to the treatment area. If you were asked to change into a gown when you had your treatment planning CT, you will also do the same before each treatment. The therapist will then position you onto the treatment table exactly the same as the treatment planning CT. The treatment table is long and narrow and has a hard flat surface. The table can move up and down side to side and can be rotated. The room itself is usually set at 70 degrees to allow the machine to function properly. The lights in the treatment room will be dim and the therapist will use red positioning lasers like those from the simulation to align your reference tattoos made during the planning CT. Once you and the tattoos are properly aligned with the linear accelerator, the therapist will make shifts using coordinates from the treatment plan to get to the exact location on your body where the radiation will be directed. Using a black sharpie marker, the therapist will then mark the location on your skin. After you are properly aligned, the therapist will take a series of x-rays or port films before the treatment to verify that the marks on your skin match the treatment plan. Your radiation oncologist will view the x-rays and determine if there are any necessary changes that may be needed to match the treatment plan exactly. Once the port films are approved by your radiation oncologist, you are ready for the first treatment. Your first treatment may begin immediately following the port films or may start the following day. Before you leave, the therapist will take several digital photos of the marks, and treatment area drawn on your skin to keep in your chart for documentation. The therapist will then instruct you to KEEP the new marks drawn on your skin and not to wash them off. These new marks will be used to align you every day for your treatment and will decrease the time it takes to set you up. To help preserve the marks during showering or bathing, do not scrub at the marks and pat dry when finished in the marked area. The therapist will darken the marks before each radiation treatment.
Step Six - What to expect during Radiation treatments
The radiation treatments are similar to having an x-ray taken, you will feel nothing and the treatments are painless. You will be positioned exactly the same way you were positioned during your treatment planning CT and for the port filming. Once aligned with the linear accelerator, you will be asked to hold very still and to breathe normally for the entire treatment. The linear accelerator will be moving around you to get into the predetermined position needed to deliver the radiation. The machine is capable of moving 360 degrees around the area to be treated and usually involves receiving radiation from several different angles. During the treatment, you will hear the machine making a buzzing or humming sound and hear the motors of the lead leaves that shape your radiation field moving into the correct position. During your treatment, the therapist will leave the room and will operate the machine from the control area outside the treatment room. From the control area, the therapist can hear and see you on a video and audio monitor at all times and can also communicate with you if necessary. If you should happen to feel sick or believe you have moved off your marks, let the therapist know as soon as possible, the accelerator can be stopped at any time during your treatment. On average, most patients can be positioned and given their treatment within 15 minutes. The actual time the radiation is on can range from 1- 4 minutes. Once a week or every five or six treatments, the therapist will take port films to verify your treatment set-up is correct. These x-rays or port films are to check positioning only and are not used to evaluate your current condition. Your radiation oncologist will also meet with you on a weekly basis throughout your course of treatment to answer questions and to check how you and the treatments are going. Always feel free to ask your radiation therapist and radiation oncologist questions.
Step Seven - Side effects from Radiation Treatments
During the course of therapy and if your condition permits, you are encouraged to continue your normal, daily activities, including work. However, you may experience some side effects that may often be minimized with diet or medication. With the technology NIOC has available today, side effects from the radiation treatments have been greatly improved upon. Radiation only affects the part of the body being treated. Side effects can be different from patient to patient depending on the total radiation dose delivered and area of the body being treated. Often, patients will not experience any side effects until 3-4 weeks into their treatment and they may last for up to several weeks after the completion of the treatments. General side effects from radiation therapy can include skin changes, fatigue, and decreased blood counts. Other side effects are dependant on the area being treated. For instance, treatment to the abdomen may cause nausea, vomiting, or diarrhea and radiation to the head and neck area can cause difficulty swallowing, dry mouth, mouth sores, or temporary loss of taste. The radiation oncologist and the radiation therapist will monitor your treatments and your overall health during the entire course of your radiation therapy. Always feel free to address concerns, and let the therapist or oncologist know about any side effects you may experience.
Step Eight - Follow-Up Appointment
At the conclusion of your radiation treatments, periodic follow-up appointments will be scheduled with your radiation oncologist to follow-up on your health status. You will also be seeing other doctors after your treatments including your family physician, medical oncologist and/or surgeon. Your radiation oncologist will determine how frequently you will need to be seen. At this time, the radiation oncologist may order lab tests, x-rays or other diagnostic procedures. In most cases, shortly after your treatment ends, you will be able to resume your normal daily routine. One of the most important things you can do for yourself before, during and after treatment is to maintain a positive attitude. Your mind is a powerful healing tool and can be your strongest ally on the road to recovery.
Frequently Asked Questions
What is cancer?
Cancer can best be described as abnormal cells displaying uncontrolled growth. These abnormal cells develop from damaged DNA and tend to rapidly divide to form a group of abnormal cells called a tumor. Most cancers form a tumor and some, like leukemia, do not form tumors but involve the blood. Tumors can be either benign or malignant. Benign tumors are noncancerous and do not invade or spread to other parts of the body. Malignant tumors are cancerous and can grow outside their boundaries and have the potential to invade nearby tissues or organs. When the malignant cancerous cells spread to other parts of the body, it is called metastasis.
What is Radiation?
Radiation is the transmission of energy through a material or through space carried in the form of waves or particles. The radiation can be produced from special machines like the linear accelerator or can be omitted from a radioactive source such as Iodine-125, Cesium-137, or Cobalt-60. Radiation is produced inside a linear accelerator by accelerating electrons toward a metal target causing a collision and as a result, high-powered x-rays are produced.
What is Radiation therapy?
The use of high-energy particles or waves such as x-rays, electrons, protons or gamma rays to treat cancer cells, residual disease, or other illnesses is called radiation therapy. Sometimes it is also called radiotherapy, irradiation, x-ray therapy, or electron therapy. Radiation used for radiation therapy is prescribed at higher doses than those used for diagnostic x-ray procedures.
How Does Radiation Therapy Work?
Radiation therapy is a local treatment that focuses only on the part of the body being treated. When radiation is delivered from a linear accelerator at high doses, it can kill or damage cancerous cells by damaging DNA strands inside the cancer cell inhibiting the cancer cell to grow and divide. Radiation Therapy is very useful because it damages the cells that are rapidly growing and dividing such as cancer cells. Radiation therapy can be used to cure, slow, or stop the growth of cancer cells. Radiation can also be used to alleviate symptoms like pain, pressure, or bleeding.