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Cancer Care

What Can Patients Expect?


Welcome to Radiation Oncology

Our staff is prepared to deliver a treatment program that meets your unique needs.  We are equipped with the latest technology, and we have highly skilled specialists ready to serve on your treatment team.  We are committed to making your treatment as effective and comfortable as possible.

The following information is provided to give you a better understanding of what to expect during your course of treatment.  Please read through this information and contact us with any questions you may have.

Treatment Program
Your radiation oncologist determines how many days/weeks you need to be treated with radiation.  The doctor bases the length of your treatment course on several factors and may lengthen or shorten your course at any time.  The course could range in length from ten to forty treatments (or two to eight weeks). 

The treatments are given on Monday through Friday.  We treat only emergency cases on Saturday and Sunday.  You should use these two weekend days to rest.  The radiation may cause you to be more tired than usual and you need to try to keep your strength up as much as you can.  You will see your doctor and a nurse weekly to check your status.  However, you may request to see them at any time.

Treatment Team
During the course of your treatment you will meet a number of health care professionals who make up your treatment team.  Members of the department include:

  • Radiation Oncologist - a medical doctor specialized in using radiation to treat disease.
  • Radiation Oncology Nurse - provides nursing care and education about treatment as well as the management of possible side effects you may experience.
  • Radiation Therapist - licensed professional that positions you for your treatments and operates the equipment that delivers the radiation.
  • Dosimetrist - performs the calculations and computer planning for your treatment.
  • Radiation Physicist - performs routine review of treatment plans and quality control of the department machines to assure the radiation dose received by the patient is accurate and safe.
  • Receptionist/Secretarial Staff - obtain needed medical information for treatment, schedule necessary appointments and assist in answering any questions you may have.


Treatment Machines


Simulator and Planning Systems
There is one simulator and three treatment planning computer systems in our department.  The simulator is a specially designed diagnostic x-ray unit.  It is used exclusively for designing your treatment fields.  The high speed computer planning system allows the physics and dosimetry staff to perform dose calculations for the treatment.

Linear Accelerators
The linear accelerators are the treatment machines that will be used to deliver the radiation, according to the treatment plan developed from the information obtained during the simulation process.  The simulator and linear accelerators are quite large and can be intimidating at first, but they are safe and reliable.  At no time will you actually feel the radiation given for your treatment; it can be compared to a regular diagnostic x-ray.       

Simulation Process
To develop the most effective treatment plan for you, we need to define the location of your tumor site and what structures need to be included in the treatment area.  This treatment planning session is called simulation.  It takes about one hour to accomplish and will be scheduled after you meet with your Radiation Oncologist.  Some more complex treatment simulations may require more than one hour, or more than one simulation.

During both the simulation and subsequent treatment sessions it is important that you remain still.  The table you will be lying on will be hard and flat, but we will make you as comfortable as your treatment planning will allow.  Tape, straps, or special immobilization devices are sometimes used to help you maintain the treatment position. 

During simulation the Radiation Therapist, under the direction of your doctor, takes x-rays and measurements and marks the treatment area on your skin.  These skin marks will aid in reproducing your exact positioning each day for treatment and will be placed using a special pen or liquid skin dye.  Sometimes a Dosimetrist may come in during the simulation to take additional measurements for a computer treatment plan.  Photographs will be taken for identification and positioning purposes.

In some situations the doctor may request that contrast be used.  Contrast allows us to see certain parts of your body that would not normally be seen on an x-ray.  This could involve drinking a liquid contrast agent, receiving an injection, or having a small tube placed in your rectum.

A contour (outline or shape) may be taken of the part of your body that will be treated.  This is usually done using plaster strips.  They will be placed on you warm and wet.  The plaster will dry and conform to your shape in about 10 minutes.  Once it has dried, the plaster will be removed. This will be used along with other simulation information in planning your treatment.         

When simulation is completed, the simulator therapist will give you an appointment for your daily radiation treatments, which will usually start within a few days after the simulation.

Immobilization Devices
An immobilization device is something that we may use to help you stay perfectly still.  We may also place treatment field marks on the immobilization device.  If a device is needed it will be made during the simulation before the films are taken.  These are constructed especially for each patient and will increase the amount of time for simulation. 

For specific simulations such as planning done in the head and neck area, and sometimes the pelvic region, an aquaplast mold will be constructed.  Aquaplast is a plastic mesh sheet  that becomes flexible when heated in water.  This allows the therapist to place the sheet over the area of interest and form it as needed.  It will be warm and wet.  As it cools it keeps the shape it was molded to and will be used to reproduce your positioning for your daily treatments.

Port Films

Port films are films taken with the actual treatment machine.  They are different from diagnostic x-rays and are used only to see the anatomic position (bones primarily) and not to assess tumor response.  Port films will be taken the first day in the treatment room.  You will be lying on the treatment table in the same position as you were in the simulator.  Port films will only confirm that the treatment area matches the area that was simulated.  It is not unusual to require additional port films after the first day.  The therapist will tell you if the film needs to be taken again.  You can assume if the film is not repeated the next day, then your positioning does not need any adjustments.  Port films are taken every week to verify continued accurate positioning.

Daily Treatment
It will take about 15 minutes to receive your treatment each day.  Most of that time will be spent getting you in the exact treatment position.  The actual radiation will only be "ON" for about 30-45 seconds for each treatment field.  Depending on your treatment plan, you will receive from one to as many as six treatment fields each day.  You need to hold very still for your treatment, but do not try to hold your breath.  Breathe as evenly and normally as possible. 

The therapist will be outside the room during the time the radiation is actually on.  At all times, the therapists will be able to see you on closed circuit television monitors and communicate with you by intercom.  In the event you may need a therapist during the actual treatment delivery, call out or wave your arms.  The therapist will turn off the radiation and come in the room to assist you.

Your treatment may require multiple fields or a single field.  The therapist may enter the room between these fields, but please do not move.  Once you are positioned for your treatment do not move until the therapist tells you the session is completed.  You will not feel anything during the treatments just as you would not during regular x-rays.

Cone Down/Boost
After a certain number of treatments, your doctor may order a "cone down" or "boost" of the area being treated.  This means that the original treatment area is reduced in size to be able to continue delivering dose to the original cancer site while protecting some surrounding tissues and structures.  The cone down or boost will often require another simulation to create a revised treatment plan.  This will be scheduled in advance by your treatment therapist.

Skin Marks
At the time of simulation, marks will be placed on your skin to outline the area to be treated.  These marks need to stay on your skin throughout the course of treatment and will be darkened as needed by the therapist.  Please be careful of these marks when showering.  You should not use soap or scrub this area. 

If you notice that your marks have faded, DO NOT attempt to darken them on your own at home.  If there is ever a question of the accuracy of these marks, or if they have faded too much, you will need to go back into the simulator and have the marks redrawn.  If you are concerned about your marks, please notify your therapist.

A Note About Appointments
It is very important that you arrive for your treatment appointments on time.  Every patient is given a minimum15 minute time slot and has been carefully fit into the structure of the daily schedule.  If you arrive early, it may not be possible to take you early. 

We understand that your time is valuable and we work hard to keep to the schedule, but there may be some instances when there are delays and you will have to wait past your appointment time.  If possible, we will attempt to notify you in advance of any delays.  If this happens we apologize and appreciate your patience. 

If you run into a conflict with your daily appointment time, please notify the therapists with as much advance notice as possible.  They will do their best to adjust your appointment for that day to accommodate you.

Parking
Parking for outpatients is provided in the west end lot and the AMC parking garage.  Valet parking is also available at both the east and west entrances of the hospital.  You will be given a ticket that can be validated by the Support Staff in Radiation Oncology, whether you use the garage or valet service,as parking for our patients is free of charge.  The parking lot directly in front of the Radiation Oncology/Radiology entrance does have a limited number of handicapped spaces available and patient drop off is permissible.

Skin Care
During your course of treatment, you may notice some redness, itching, dryness or darkening of your skin in the treatment area.  These are normal reactions to the radiation therapy.  They may become more noticeable as treatment continues, especially if you have had any chemotherapy. 
Below are some guidelines for the care of your skin while you are receiving radiation therapy:

DO

  • Wear soft, loose clothing over treatment area
  • Keep the skin in the treatment area clean, dry and open to air
  • If shaving the treatment area, use electric razor
  • Avoid injuring the skin or exposing it to the sun or wind
  • Use Aquaphor or Eucerin moisturizer only as directed
  • Use baking soda or cornstarch as directed
  • Inform your doctor or nurse if you have irritation or pain

DO NOT

  •  Use any soap, cream, lotion, medication, deodorant powder unless directed
  • Use heating pads, hot water bottles or ice packs in the treatment area
  • Rub or massage the skin in the treatment area
  • Use tape of any kind on skin in the treatment area
  • Wash off or remove any marks on your skin
  • Replace, retrace or remark your skin

Bloodwork
Your blood counts will be monitored while on radiation treatment.  In general samples are taken every two to three weeks, depending on the type of radiation you are receiving and if you are also having chemotherapy treatments.  Most blood work results are available in two days, and if they are not normal, you will be informed.  If you have questions, please ask one of the nurses.

Medications
A complete list of current medications is requested for review including over the counter medications.  Please inform your physician/staff of any additional changes in medications during your treatment. 

A basic multivitamin, one without a high concentration of vitamins or herbal supplements may be taken (i.e.: CVS brand, One-A-Day, or "Basic" Centrum).  We will be available to discuss what medications may be resumed upon completion of treatment.
  
Follow-up Visits
Your radiation oncologist may request that you return to this department for follow-up visits.  The routine follow-up visit schedule is 1 month although this can vary for each patient.  Your radiation oncologist may suggest that you alternate some of your follow-up appointments with your other oncology physicians.  At the end of your course of treatment you will be notified of the intended follow-up plan.

Billing/Statements
Patients for radiation therapy services receive two (2) bills:

  1.  Physician services
  2.  Hospital or technical services

Please note that there may be hospital and physician charges for dates when you are not physically here in the Radiation Oncology Department.  A variety of activities may have occurred, such as computerized treatment planning, 3-D digital reconstruction, and shielding design and construction.  These activities will be billed for the actual day that they are performed.  The staff will be utilizing your chart, films and/or scans. 

Questions?    Please Ask.
Speak with a nurse
To speak with a nurse call (518) 262-3368, Monday through Friday, 7:30 to 4:00 p.m.

Speak with your doctor
To contact your doctor after regular business hours, call the Radiation Oncology answering service at (518) 292-0259, and follow the instructions given to you.

Emergencies
In an emergency, report to the nearest emergency room and ask them to contact your doctor.

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