What to Expect: Radiation Oncology
Before Treatment
Consultation
If you are a candidate for radiation therapy,your primary care physician, or surgeon likely will help you schedule a visit with Dr. Bhatnagar. During your first visit, Dr. Bhatnagar and our nursing staff will perform a medical examination along with prescribing necessary diagnostic tests, which may include CT scans, MRI scans and/or Positron Emission Tomography (PET) scans, in order to assess your disease. He will also review your current medical problems, past medical history, past surgical history, family history, medications, allergies and lifestyle. After performing this comprehensive evaluation, Dr. Bhatnagar will determine whether radiation therapy is right for you.
Dr. Bhatnagar will outline appropriate therapy option(s) with you and your family and will answer any questions you may have. He will explain the potential benefits and risks of his recommended treatment and the expected results. Once a treatment path is determined, Dr. Bhatnagar and his staff will give you a tour of the facility and introduce you to the various pieces of technology he will use, including CTSA's Trilogy™ linear accelerator.
Simulation and Treatment Planning
Prior to creating an individualized treatment plan for you, a simulation must be performed. The purpose of the simulation is to measure your anatomy, mark the skin and/or form immobilization devices in order to deliver the radiation dose to the exact location of the tumor. Simulation is carried out on a CT scanner, which produces 3D images of your anatomy. These images help the radiation oncology team determine where the beams should be focused to target the tumor and spare as much healthy tissue as possible.
Stimulation Process:
- Simulation begins with our team placing you on the CT table in the exact position in which you will be during actual treatment with the linear accelerator.
- If needed, immobilization devices (molds, casts, headrests, or other devices) are formed to position you for treatment.
- The radiation therapist marks the regions either directly on the skin or on the immobilization devices.
In addition to the steps above, Dr. Bhatnagar may require special blocks to be created for you. These blocks are inserted into the external beam therapy equipment prior to each of your treatments. They are used to enhance the shape of the beam, which will allow the tumor to be targeted more accurately thereby sparing surrounding normal tissue. The Trilogy system also has built-in blocks or shields known as multi-leaf collimators that will shape the radiation beam.
The simulation process is typically performed in one visit. However, in some instances Dr. Bhatnagar may schedule you for more simulations depending on your cancer diagnosis and the type of radiation therapy that will be used.
A treatment plan is configured after Dr. Bhatnagar and members of the radiation oncology team examine the information acquired from the examination and simulation along with other diagnostic evaluations. An advanced treatment planning algorithm is used to devise and generate a unique treatment plan for you. Lastly, Dr. Bhatnagar reviews and finalizes the treatment plan by writing a detailed prescription for your course of radiation therapy. As your disease changes during treatment, this treatment plan can be updated to ensure that the cancer can be targeted accurately.
During Treatment
External Beam Radiation Therapy Treatments
External beam radiation therapy is a time-efficient outpatient treatment that is conducted over a predetermined period of time. Radiation therapy is typically scheduled 5 days a week on a daily basis and can continue for up to 10 weeks. Dr. Bhatnagar will determine how many treatments you will receive depending on the size, type or location of the tumor. The Trilogy system permits the radiation beam to penetrate the skin and accurately strike the tumor without any physical contact with the equipment. Consequently, this is a non-invasive painless procedure for patients.
Process of administering external beam treatment:
- Dr. Bhatnagar will provide thorough instructions, through a prescribed treatment plan, to the radiation therapist for your specific treatment.
- You will be positioned for treatment on the treatment table.
- If applicable, immobilization devices will be placed in their appropriate predetermined locations during each treatment in order to position you correctly for therapy.
- After proper positioning and setup, the therapist will leave the room and enter the adjacent control room. While in the control room, the therapist will continuously monitor you through a display screen. In addition, there is a speaker system in the treatment room for you to talk to the therapist if you have any questions or concerns.
- The radiation therapist may move the machine and/or treatment table in order to correctly aim the radiation beam to the precise location of the tumor.
- The prescribed radiation dose will be input into the system for delivery.
- Dr. Bhatnagar and the radiation therapist will administer the prescribed radiation dose.
Although the radiation therapy team makes every effort to reduce exposure to surrounding cells, it is nearly impossible to avoid exposing adjoining tissue altogether. However, most patients are able to recover from this minimal exposure between each daily treatment. Due to potential side effects, there may be instances where treatment is ceased for a day or more. Most missed treatments can be rescheduled by adding the treatments to the end of the original cycle. Most patients are treated on an outpatient basis and many are able to continue with normal daily activities during their courses of treatment. During your course of radiation treatment, Dr. Bhatnagar may change your radiation dose depending on your reaction to the treatment. Additionally, he may request blood tests and more diagnostic tests in order to better assess your response to the radiation therapy. Another simulation may be ordered if the tumor changes substantially early in the treatment process.
On Treatment Visit (OTV)
In addition to receiving radiation treatment, Dr. Bhatnagar will consult with you routinely so as to follow your progress and address any questions or concerns you may have. During these visits, he will also determine if you are experiencing any side effects and prescribe medication or recommend lifestyle changes (i.e. change of diet) to remedy occurring side effects. As your treatment therapy proceeds, Dr. Bhatnagar may modify your schedule or treatment plan depending on your response to the therapy.
Daily and Weekly Beam Films
The Trilogy system has an On-Board Imager™ (OBI) that has the ability to take periodic cone beam CT scans or X-rays (of diagnostic quality) immediately prior to treatment. These images ensure accurate setup so that the treatment beams remain directed precisely at the target. Dr. Bhatnagar is then called to the treatment console to evaluate these images and determine if any shifts need to be made just prior to treatment. In addition to this daily localization process, the cone beam CT can also be used to monitor the progress of some tumors, such as lung tumors or head and neck cancers, which could prompt Dr. Bhatnagar to create a new radiation treatment plan due to the changes in the tumor shape.
In addition to the OBI images, other images known as port films are generated weekly from the treatment machine for Dr. Bhatnagar to review. He consistently examines these films to ensure that the radiation beams are always aimed precisely at the target site throughout your course of treatment.
After Treatment
Follow-Up
Once your course of treatment is complete, follow-up appointments are scheduled with Dr. Bhatnagar so he is able to assess your recovery and health status. Dr. Bhatnagar may also order additional medical tests and reports on your treatment, which can be sent to your other doctors.
Over time, the frequency of your follow-up visits will decrease. However, if you should have any questions or concerns, your radiation oncology team will always be available to address these for you.
