Treatment Process

Treatment Process

The IMRT/IGRT treatment process generally consists of several steps, including consultation, positioning and CT-simulation, treatment planning, and treatment delivery.  A dedicated team of medical professionals will guide you and work with you every step of the way.

Step 1: Consultation

The first step is to meet with your radiation oncologist, who will review your medical history, diagnostic imaging reports, pathology reports, conduct a physical examination and set an appointment for you for the subsequent steps.

Step 2: Positioning and CT-Simulation

This step is basically the preparation step, whereby the daily treatment position will be determined. Special molded immobilization devices that help you maintain the same treatment position every day are developed at this point.

A CT-simulation will be done in the treatment position, using the custom-made immobilization device. The images captured in the CT-simulation will be used for detailed three-dimensional computer planning that guides the radiation oncologist in mapping out the area to be treated. Please note that intravenous contrast injection may be requested by your radiation oncologist.

After the CT scanning is completed, several tattoos will be made on your body. Tattoos are tiny ink dots made on the skin to mark out permanently the radiation treatment. The tattoos are made by injecting little drops of Indian ink underneath the skin. It is important to have these tattoos as they assist in daily positioning. Localization marking will also be placed on your body using permanent ink marker. These markings are not to be removed until you have been told you can do so.

Following the CT-simulation, the computer planning process will commence, and it will usually take several days to complete. You will be given an appointment to begin radiation treatments.

Step 3: Treatment Planning

Using the information gathered in positioning and CT-simulation, the medical team designs the best treatment plan for your situation.  As part of the treatment planning, your medical team conducts extensive quality assurance testing with the treatment equipment to be sure that your planned treatment can be accurately executed. You do not have to be physically present for this step.  

Step 4: Treatment Delivery

IMRT usually is given five days a week for six or seven weeks. When radiation is used for palliative care, the course of treatment lasts for two to three weeks. For each IMRT/IGRT session, the patient is in the treatment room for about 20 to 25 minutes.  The first IGRT treatment session is usually longer than subsequent ones so that additional X-ray imaging and verification can be executed. 

In the treatment room, you will be positioned on a treatment couch in a way that is identical to the treatment position determined during the CT-simulation procedure, with or without the custom-made immobilization device. The radiation therapists use the tattoos and localization marks on your skin to locate the treatment area and to ensure accurate positioning of the treatment area.  

The radiation therapists leave the treatment room and remotely control the imaging device to fine-tune your treatment position and move the treatment couch into final position.  The imaging device rotates around you to take digital images of the targeted area.  Usually two or more images are taken from different angles.  A complete rotation of the machine may be used to generate a three-dimensional image.  These images are then used to guide the final adjustments of the treatment couch. Radiation treatment begins once the final treatment position is finalized and achieved.

The radiation treatment given by the linear accelerator is invisible and you will not feel it, just as you do not feel an X-ray.  The accelerator emits a buzz as it produces the radiation beams.  The accelerator’s gantry head will move around you to the first treatment angle specified in your treatment plan, administer radiation, and then move to the next specified angle to administer radiation. The number of angles depends upon your treatment. There will be no direct physical contact between you and the moving gantry head. It is important to lie as still as possible during this time, so that the radiation dose is delivered to the exact same treatment area each time.

Although you are alone in the treatment room, you can be observed on a television screen.  The therapists can talk with you through an intercom. You can also give signal to the therapists when you need any form of assistance.

Follow-Up Care

When your course of treatment is completed, you will have a series of follow-up visits in which your radiation oncologist will monitor your condition and the effects of the treatment.  Your doctor may request blood tests, X-rays, and/or scans at these appointments.  Discuss with your doctor how to stay healthy after treatment.  Ask about nutrition, exercise, and environmental changes that could help you maintain a healthy lifestyle.  Equally as important, find out about support groups for cancer patients and survivors, so that you can connect with others who have had similar experiences. You will be able to find out such information in the Cancer Resource Center.