Planning the EBRT treatment

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

After the planning session, your radiation oncologist will work out the total dose of radiation needed and the total number of treatments. This can take a few hours or urgent treatment or several days to weeks depending on your treatment needs.

Learn more about:

• Consultation session
• Planning session
• Helping you stay still
• Skin markers

Consultation session

• May take up to 2 hours.
• To assess whether radiation therapy is the right treatment for you, the radiation oncologist will talk to you and look at all your test results and scans. They may do a physical exam.
• The radiation oncologist will then explain how radiation therapy will help you, what will happen during planning and treatment, and what side effects to expect.
• You will also meet the radiation oncology nurse and a radiation therapist. They can provide support and further information. They will usually explain what side effects to expect and how to manage them.
• The radiation oncologist may arrange further x‑rays, scans or other tests to find out more about the cancer.
• Consider taking a family member or friend with you to keep you company, ask questions and make notes.
• Ask what you will have to pay for treatment.

Planning (simulation) session

• This is usually done soon after the consultation session. It lets your treatment team work out how to direct the radiation and best position your body for treatment.
• You will have a planning scan. It may be a CT, MRI or PET scan.
• You will have the planning scan in the same position you will later be placed in for treatment.
• If you are having radiation to the chest area, you may need to hold your breath during the planning scan. You may also have a special CT scan, called a 4DCT, to track your breathing, or be taught how to take deep breath holds.
• If you are having radiation therapy to the pelvic area, the size of your bladder and bowel will be checked during the scan. You may be asked to drink a set amount of water before each treatment session to make sure the bladder is full and the area having treatment is in the same position each time. You might also be asked to empty your bladder or bowel.
• The images are sent to a special computer that lets the radiation oncologist and radiation therapists work out how to direct the radiation.

Helping you to stay still

• You may need some type of device to help you stay in exactly the same position for each treatment session and keep still for around 5–10 minutes.
• 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 area, you may need to wear a plastic immobilisation mask. This will be made to fit you. A mask can feel strange and confining, but you will still be able to hear, speak and breathe.
• Some centres offer surface guided radiation therapy (SGRT). This uses special cameras to position you on the table and monitor your body’s movements during treatment. This means you won’t need an immobilisation device or skin markings.

Markers

• To make sure you are in the same position each session, a few 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 therapists if you can wash these marks off or if you need to keep them until the end of the treatment. The ink may be redrawn during the course of treatment, but it will gradually fade. Invisible tattoos may also be available.
• If you have to wear a mask or cast, the markings may be made on this device rather than on your skin.
• To help with image‑guided radiation therapy, as well as tattoos you may have a surgical procedure to insert small markers into or near the cancer. The markers (called fiducials) are made of gold and are about the size of a grain of rice. These markers can be seen on scans during treatment.

→ READ MORE: What to expect at treatment sessions

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