What Happens in the days before treatment CTSimulation

What Happens in the days before treatment ? CT/Simulation Contouring images Treatment planning Radiation Field Design Quality Assurance Iso-center check

CT/Simulation A series of detailed pictures taken of areas within the body to precisely locate and mark the target (cancer) area that is going to be receiving the radiation therapy.

CT/Simulation

Contouring Images The Images from your CT/Simulation are downloaded into a treatment planning program. Then, the important anatomy in and/or around the radiation therapy field are outlined.

C O N T O U R I N g Head/Brain Head and Neck Bladder Lungs Femoral Head Heart Prostate Rectum Liver Kidneys

Treatment Planning This is a process in which the Physician, Physicist, and Dosimetry staff work together to optimize delivering the highest prescription dose to the target area while minimizing radiation to the normal anatomy.

Treatment Planning Collaborative effort of Physician, Physicist, and Dosimetry Staff

Radiation Field/Beam Design The radiation fields will be designed according to the Physician’s prescription with the aid of the treatment planning system. This 3 -D shaping (modulation) helps prevent/minimize radiation dose to the surrounding healthy anatomy.

Radiation Field Design MLC (Multi Leaf Collimation) • The Radiation Beam is Shaped (modulated) internally; • inside the Treatment Machine. There are hundreds of interlocking lead ‘leaves’ working together to create one unique dynamic shape altering the 3 -D effect of the radiation beam.

Radiation Field/Beam Manipulation by Designing the MLC Pattern • The design of the MLC pattern is based solely upon • the patients unique anatomy in correlation to the physician’s prescription. As the radiation beam travels through the MLC pattern the intensity of the beam is shaped (modulated) as it enters the target area (cancer). Meaning, the target area (cancer) is receiving the highest prescription radiation dose and the surrounding healthy anatomy is receiving the absolute minimum amount of radiation.

Quality Assurance Testing Upon finishing the Radiation Therapy Treatment plan, our physicist will perform a series of QA testing to ensure that the radiation dose we are delivering to the patient is exactly what the prescription calls for prior to the start of treatment.

Isocenter Check (Verification CT Simulation)

Isocenter Check This is a process in which we verify the center of the radiation field that correlates with the center of the target (cancer) area receiving radiation. In addition this confirms that the patient’s position is accurate. This procedure produces the final markings of the radiation field. (3 points) Note: Patient will get permanent tattoo marks the size of a small freckle. (Usually 3)

Scheduling the Treatment Course • Treatment days are Monday-Friday, no weekends. • A standing appointment time will be set up prior to the first day. • • • It is important to have the same appointment time everyday but arrangements can be made from time to time. Our clinic tries very hard to accommodate the patient’s home and work schedules; however, appointments may be limited to overall volume. In the event we are closed for a holiday or for an unexpected circumstance, we will take the days missed and add them to the end of your treatment. Try not to schedule travel plans within close proximity (5 -7 days) to the end of the treatment date because that date could change.

Treatment Day Treatment Machine Radiation Therapist work station

What to Expect during Treatment • Most people are nervous the first couple of days of • • treatment; however, the actual treatment received on a daily basis is the easiest part of the entire process. There is no sensation at all from start to finish from the radiation. Ex, getting an X-ray. The Patient is monitored by sight and sound 100% of the time while in the treatment room. It is extremely important to lay completely still during treatment. Please empty pants pockets of unnecessary items prior to entering room. Ex: coins, wallets, knives, combs. . *** Note: The Treatment table can be elevated 5 feet off the ground so never attempt to dismount the table without the help and direction from a therapist.

Things to Make note of while undergoing Radiation Therapy

Nutrition While Undergoing Radiation • Please eat balanced meals, and stay well hydrated. • Do not try to diet or lose weight during the treatments. • It is extremely important that patients try and maintain • • the same weight throughout the entire course. Weight gain or loss over 10 lbs may result in re-planning. Weekly Weights will be kept on record.

General Side Effects • Fatigue may occur as you near the end of treatment • Hair loss or thinning of hair in the treated area may occur and is likely to re-grow • Irritation/Redness to the treatment area may occur depending on the site of treatment

General Side Effects • Please report all possible side effects or issues to any staff members ASAP. Thank you