Planning the EBRT treatment

EBRT needs to be carefully planned to ensure that enough radiation reaches the cancer, while as little as possible reaches healthy tissues and organs. The planning steps below may occur over a few appointments.

Learn more about:

• Consultation session
• CT planning session
• Helping you to keep still
• Skin markings

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Consultation session

• May take up to two hours.
• Your radiation oncologist will assess whether radiation therapy is the right treatment for you by talking to you, doing a physical examination, and looking at all your tests and scans.
• The radiation oncologist will explain the benefits and side effects of radiation therapy and what to expect during planning and treatment.
• You will also meet the radiation oncology nurse and a radiation therapist. They can provide support and information.
• The radiation oncologist may arrange further x-rays, scans or other tests to find out more about the cancer.
• You may want to take someone with you to keep you company, ask questions and make notes.

CT planning session

• You will need a planning CT scan even if you had a CT scan to diagnose the cancer. This step, known as CT planning or simulation, is usually a few days after the consultation session.
• You will have this scan in the same position you will be placed in for treatment.
• The images will build up a three-dimensional picture of your body. This will show the exact location that needs to receive the radiation.
• The radiation therapists will send the images to a computer. This allows the radiation oncologist to outline exactly the area they need to treat. The oncologist will prescribe the appropriate dose of radiation, which will help the medical physicist and therapists plan the treatment.
• You may have a special CT scan to track your breathing or short breath holds. This may improve treatment accuracy and reduce side effects.

Helping you to keep still

• You will usually need some type of device to ensure you are in the exact same position for each session and to help keep you still during treatment.
• This is known as an immobilisation device. It will be made during the CT planning session. Depending on the area being treated, the device could be a breast board, a knee or foot cushion, or a bag that moulds to the shape of your body.
• For radiation therapy to the head or neck, you may need to wear a plastic immobilisation mask. This will be custom-made to fit you. A mask can feel strange and confining, but you will still be able to hear, speak and breathe.
• Depending on the area being treated, a device known as a spacer may be inserted to move normal tissue away from the area receiving radiation. Examples of spacers include gels and balloons.

Skin markings

• To make sure you are in the same position each session, a few very small permanent ink spots (tattoos) may be marked on your skin. These tattoos are the size of a small freckle and can’t be easily seen.
• Sometimes temporary ink marks are made on the skin. Ask the radiation therapist if you can wash these off or if you need to keep them until the full course of treatment is finished. The ink can be redrawn during the course of treatment, but it will gradually fade.
• If you have to wear a mask or cast, the markings may be made on this rather than on your skin.
• For image-guided radiation therapy, you may have a small surgical procedure to insert markers (usually gold grains) into or near the cancer. These internal markers can then be seen on scans during the treatment.