University of California San Francisco
Helen Diller Family Comprehensive Cancer Center

What to Expect

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Your initial consultation

Your first visit to a radiation oncologist is called a consultation. Its purpose is for the physician to assess your medical condition and perform a physical examination. Your diagnostic X-ray studies, pathology slides and/or reports will be reviewed to determine if you will benefit from a course of radiation. Other treatment options that may be appropriate for you to consider may also be discussed.

The radiation oncologist will confer with your referring physicians. The expected benefits, risks and outcome of your treatment will be explained.

The initial consultation typically takes one to one and a half hours. It is important that you bring a list of medications you are currently taking (including over-the counter medicines and dietary supplements) with you as well as the health questionnaire that you were asked to complete.

For patients who do not speak English, an interpreter will be provided by UCSF.

At the time of the consultation, you will meet with the attending radiation oncologist and his or her primary nurse. A resident, who is a physician training to become a board-certified radiation oncologist, may also see you.

You may want to have a family member or friend accompany you to assist in talking with the doctor and help you remember what is discussed. If a decision is made to proceed with radiation, you will receive an appointment to return for the next step- a treatment "simulation" prior to beginning actual treatment.

The consent

Before you begin radiation therapy and after your questions have been answered, you will be asked to sign a consent form. Signing the consent form indicates that you understand the risks and benefits associated with the radiation treatment and that you agree to proceed with the proposed treatment course. This will give you an additional opportunity to ask questions of your physician and review the possible side effects and outcome of treatment.

Simulation

The simulation is the first step in planning your radiation treatment. The purpose is to identify the area to be treated. Before simulation begins, a photograph of your face will be taken for identification purposes. During simulation you will be positioned on a table, usually lying on your back. Custom molds or casts may be used to help you keep this position on a daily basis. The simulation may take up to an hour. Several medical professionals will be present. They include your physician and his or her resident and the simulation therapist(s).

Measurements and X-rays of the area to be treated will be taken to determine the direction of the X-ray beams. The simulator is a machine that mimics the movements of the actual treatment machine but produces diagnostic quality X-rays. The simulation may be performed on a modified X-ray machine called a simulator or a dedicated CT scan simulator or both.

Once the simulation is completed, your skin will be marked with small dots of permanent ink (tattoos) to act as a reference for set up and for future reference should you ever need radiation treatment again. These small dots assist the therapist to ensure accurate daily treatment. The dots are made with a drop of India ink and a small pinprick. They look like small freckles. Since they will not wash off, you may bathe and shower normally during the course of your treatment. If their appearance is bothersome to you, they can be removed by a dermatologist at a later date. However, they serve as a record of your treatment for future reference. We prefer that you do not have them removed.

Treatment planning

The information obtained during the simulation will be used to design a unique treatment for you. Dosimetrists and physicists who specialize in the medical use of radiation are responsible for the planning. Treatment plans are usually very complex and must take into account the area to be treated, the surrounding normal tissues and your specific shape and size. Several plans may be generated and your physician will select the best one. This process may take several days to a week.

The set-up

Once the best treatment plan has been determined and selected, you will return for a trial run or practice session on the actual treatment machine. This process, called a set-up, will take approximately one half hour on a weekday afternoon.

You will be directed to one of four treatment machines. The set-up usually occurs several days to one week after the simulation. At the time of the set-up, you will be placed on the treatment machine in your simulation position.

Several X-rays called port films will be taken to document the path of the X-ray beams. These will be compared to the plans generated by the dosimetrist or physicist. If these are approved by your physician, you will usually begin treatment the following day.

Daily treatment

The specific number of treatments you will receive is determined by your physician based on your type of cancer, its location and what other treatments are planned. Most patients are treated 5 days a week, Monday through Friday, for 5-6 weeks. The weekend permits the recovery of normal cells between radiation treatments. You will be able to come by yourself for the daily treatments. Although side effects can vary between patients, most patients are able to continue with their normal activities.

Appointment times

You will generally have your appointment for treatment at the same time every day. Routine treatments are scheduled between 7 am and 4:30 pm except for holidays.

We try to schedule treatments at times that are convenient for you. If your preferred time is not immediately available, you may take an alternate time or wait until your preferred time becomes available (provided this does not delay your treatment too long). If you must reschedule an appointment, please call us as soon as possible. We understand that emergencies and occasional conflicts may occur. However, it is important that you do not skip any treatments. The dose of radiation is cumulative; each successive dose builds on the previous one. The total dose of radiation and the time over which it is given are extremely important. Once treatments have begun, it is important not to stop or interrupt them unless otherwise medically indicated.

Checking in

When you arrive in the Radiation Oncology Department, check in at the reception desk. The receptionists will let the therapists at your treatment machine know you are here.

You will need to change into a special gown for treatment. We recommend wearing comfortable clothes that are easy to change. Lockers with keys are located in the dressing area for your security and convenience. Once you have changed into your gown, you will be escorted into the treatment room by a radiation therapist who operates the treatment machine. Each machine has two therapists and you will usually have the same team of therapists each day.

Your treatment session

Your therapist will place you in the proper position on the treatment table. For the actual treatment, which only takes approximately 10 minutes, you will not see or hear the radiation and will not feel anything. The process is like having an X-ray. It is important to lie still and breathe naturally unless otherwise directed. The treatment machines are fairly large and they move in different directions to deliver your treatment.

Your therapists will not be in the room during your treatment, but they can see and hear you at all times through a TV monitor. Your treatment is also monitored by a "record and verify" system, which makes sure that you receive only the treatment that was designed for you. This system assures the quality and accuracy of your treatment.

Once the treatment session is completed, your radiation therapist will help you off the table and you can get dressed and resume your normal schedule. You are not radioactive and do not need to avoid other people because of your treatment.

Overall you will spend about one half hour in the radiation department on a daily basis. On some days your appointment will be longer than others, for example, when you are seeing your physician.

Every five to seven treatments you will have an X-ray called a port film. It is taken during the treatment session to verify your treatment position and the direction of the X-ray beams. It does not evaluate the status of the tumor.

Weekly visits

You will see your physician and your primary nurse every week during treatment. They will monitor your progress, help you manage any side effects you may experience and address any of your concerns. This is called an on treatment visit and will occur on a specific day of the week. If you are having a problem and need to see the nurse or physician on a day other than your regularly scheduled day, stop at the nurse's station.

Note: The information and photo above was reproduced from the UCSF Radiation Oncology patient information pages on the http://radonc.ucsf.edu website.