Before Treatment
Office Hours and Appointments
Office hours are normally from 8am to 12 noon and 1pm to 5pm Monday through Friday.
If you are considering radiation therapy, you must first schedule a visit with a radiation oncologist to see if radiation therapy is right for you. Appointments for consultation are generally made in advance through your referring physician.
Appointment times for daily treatment are arranged with the radiation therapists and any changes should be made with them. Most patients are asked to return for periodic follow-up visits that are made with the receptionist on the last day of treatment.
Wheelchairs are available at the front entrance as well as Handicap Parking access directly in front of our building. Don't hesitate to ask for assistance.
If you need to contact the doctor after hours or on weekends, the on-call physician may be reached by calling the answering service at (503) 238-8363.
If you are having an emergency, call 911
What to expect on your first visit
New patients are requested to arrive at our office 15-30 minutes prior to their scheduled appointment for the purpose of registration. Medical records and diagnostic films have already been obtained from your referring physician. You will be interviewed by the nurse to obtain details of your medical history. You will then be asked to put on a gown and the physician will begin the consultation with a physical exam. After the exam you will be able to discuss the recommended course of treatment with the doctor along with family or friends if you wish.
Consultation
Before your arrival, it is likely your case has been presented and discussed at Tumor Board. This is a multi-disciplined group of physicians (surgeons, medical & radiation oncologists, pathologists, radiologists, social worker, etc.) who meet on a regular basis to discuss upcoming cases. As a group, they discuss what the best approach to treatment is for each patient who is presented to the board.
During your initial visit, the doctor will evaluate your need for radiation therapy and its likely results. This includes reviewing your current medical problems, past medical history, past surgical history, family history, medications, allergies and lifestyle. The doctor will also perform a physical examination to assess the extent of your disease and judge your general physical condition.
After reviewing your medical tests, including CT scans, MR scans and positron emission tomography scans (PET scans) and completing a thorough examination, your radiation oncologist will fully discuss with you the potential benefits and risks, potential side effects, alternative treatment options and answer your questions. Plan about 1 hour for this first visit with us.
If treatment is recommended, you will be scheduled for a treatment planning session called Simulation. Your treatment cannot be given until after this planning session has been completed.
Simulation
To be most effective, radiation therapy must be aimed precisely at the same target or targets each and every time treatment is given. The process of measuring your anatomy and marking your skin to help your team direct the beams of radiation safely and exactly to their intended locations is called simulation.
During simulation, your radiation oncologist and radiation therapist place you on the simulation machine in the exact position you will be in during the actual treatment. Your radiation therapist, under your doctor's supervision, then marks the area to be treated directly on your skin or on immobilization devices.
Immobilization devices are molds, casts, headrests, masks or other devices that are constructed and placed on a certain part of your body to help you remain in the same position during the entire treatment. The radiation therapist marks your skin and/or the immobilization devices either with ink pens or a set of small permanent tattoos.
Although simulation is typically only one session, your physician may schedule additional sessions depending on the type of cancer you have and the type of radiation therapy that is being used. This session may take from 30-60 minutes.
You will probably be asked to have a specific Treatment Planning CT Scan following your simulation. This scan is somewhat different from diagnostic scans you may have had because it is done in the same position and alignment as you will receive your radiation treatment. This planning CT scan is performed near by at the Meridian Park Hospital Outpatient Department. You will be met by one of our radiation therapists at the CT scan to setup your alignment.
All this information will be used by your radiation oncologist, the physicist, and the dosimetrist to accurately design your treatment plan.
Treatment Planning
After simulation, your radiation oncologist and other members of the treatment team review the information they obtained during simulation along with your previous medical tests to develop a treatment plan. Often, a special treatment planning CT scan is done to help with the simulation and treatment planning. This CT scan is in addition to your diagnostic CT scan. When planning your treatment, we use state of the art technologies, including PET, MRI & CT image fusion. This gives us the ability to develop multi-faceted effective treatment plans, tailored specifically for you.
Frequently, sophisticated treatment-planning computer software is used to help design the best possible treatment plan. After reviewing all of this information, your doctor writes a prescription that outlines the exact course of your radiation therapy treatment.
Your radiation oncologist may use special blocks or shields made for you. These blocks or shields are put in the external beam therapy machine before each of your treatments and are used to shape the radiation to your tumor and keep the rays from hitting normal tissue. Our treatment machine also has built-in blocks or shutters called multi-leaf collimators, which also help shape the radiation.
Pinnacle Treatment Planning Computer
During Treatment
Treatment Administration
Radiation treatment is usually given five days per week, Mon-Fri. and continues for three to 10 weeks, depending on your treatment plan. A set daily treatment time will be discussed with you on your first day of treatment. We make every effort to accommodate your scheduling requests.
Depending on your treatment plan, you may be asked to wear a gown during treatment. Patients who have been asked to change should do so before having a seat in the inner Patient Only waiting area. You will be called into the treatment room by one our radiation therapist's.
In order to avoid overcrowding and to insure the privacy of other patients at the inner waiting room, we ask that your family & friends wait for you in the outer reception area.
Each treatment will take approximately 10 minutes, unless you are having the more complex IMRT setup, requiring 30-40 minutes.
The doctor will normally see you once a week, on Friday, to monitor your treatment and discuss your progress. Your weight will be checked weekly on that day also. The nurse is available on a daily basis to answer any questions you may have. Be sure to bring to the nurse or your radiation therapist's attention any problems you may be having so it can be assessed and if necessary, see the doctor.
External Beam Radiation Therapy Treatments
When you undergo external beam radiation therapy treatment, each session is painless, like getting an X-ray. The radiation is directed to your tumor from a machine located outside of your body. One of the benefits of radiation therapy is that it is usually given as a series of outpatient treatments and you may not need to miss work or experience the type of recuperation period that can follow other treatments.
The radiation therapist will setup the equipment, position you according to your treatment plan. If an immobilization device was made during simulation, it will be used during every treatment to make sure that you are in the exact same position every day. The therapist will then administer your external beam treatment following your radiation oncologist's instructions. Each treatment usually takes less then 10 minutes unless you are having the more complex IMRT treatment which can take 30-40 min each.
Once you are positioned correctly, the therapist will leave the room and go into an adjoining control room to closely monitor you on a television screen while administering the radiation. There is a microphone in the treatment room so you can always talk with the therapist if you have any concerns. The machine can be stopped at any time if you are feeling ill or uncomfortable.
The radiation therapist may move the treatment machine and treatment table to target the radiation beam to the exact area of the tumor. The machine might make noises during treatment that sound like clicking, buzzing or whirring. These noises are nothing to be afraid of, and the radiation therapist is in complete control of the machine at all times.
The radiation therapy team carefully aims the radiation to decrease the dose to the normal tissues surrounding the tumor. Still, radiation will affect some healthy cells. The time in between daily treatments allows your healthy cells to repair much of the radiation damage. Most patients are treated on an outpatient basis, and many can continue with normal daily activities.
Sometimes a course of treatment is interrupted for a day or more. This may happen if you develop side effects that require a break in treatment. These missed treatments may be made up by adding treatments at the end. Try to arrive on time and not miss any of your appointments.
Your radiation oncologist monitors your daily treatment and may alter your radiation dose based on these observations. Also, your doctor may order blood tests, X-ray examinations and other tests to see how your body is responding to treatment. If the tumor shrinks, another simulation may be done. This allows your radiation oncologist to change the treatment to destroy the rest of the tumor and spare even more normal tissue.
Brachytherapy Treatments
Brachytherapy, also called internal radiation or seed implants, is the placement of radioactive sources in or just next to a tumor. The radioactive sources may be left in place permanently or only temporarily, depending upon your cancer. To position the sources accurately, special catheters or applicators are used.
There are two main types of brachytherapy: intracavity treatment and interstitial treatment. With intracavity treatment, the radioactive sources are put into a space near where the tumor is located, such as the cervix, the vagina or the windpipe. With interstitial treatment, the radioactive sources are put directly into the tissues, such as the prostate.
Often these procedures require anesthesia and brief hospitalization. Patients with permanent implants may have a few restrictions at first and then can quickly return to their normal activities. Temporary implants are left inside of your body for several hours or days. While the sources are in place, you will stay in a private room. Doctors, nurses and other medical staff will continue to take care of you, but they will need to take special precautions to limit their exposure to radiation.
Devices called high dose rate remote afterloading machines allow radiation oncologists to complete brachytherapy quickly, in about 10 to 20 minutes. Powerful radioactive sources travel through small tubes called catheters to the tumor for the amount of time prescribed by your radiation oncologist. You may be able to go home shortly after the procedure. Depending on the area treated, you may receive several treatments over a number of days or weeks.
Most patients feel little discomfort during brachytherapy. If the radioactive source is held in place with an applicator, you may feel discomfort from the applicator. There are medications that can help this. If you feel weak or queasy from the anesthesia, your radiation oncologist can give you medication to make you feel better.
Weekly Status Checks
During radiation therapy, your radiation oncologist and nurse will see you weekly to follow your progress, evaluate whether you are having any side effects, recommend treatments for those side effects (such as medication or diet changes) and address any concerns you may have. As treatment progresses, your doctor may make changes in the schedule or treatment plan depending on your response or reaction to the therapy.
Your radiation therapy team may gather on a regular basis with other healthcare professionals to review your case to ensure your treatment is proceeding as planned. During this session, all the members of the team discuss your progress as well as any concerns.
Weekly Beam (Port) Films
During treatment, your treatment team will routinely use the treatment machines to take special X-rays called beam or port films. Your treatment team routinely reviews these films to be sure that the treatment beams remain precisely aimed at the proper target. These X-rays are not used to evaluate your tumor.
After Treatment
Follow-Up
After treatment is completed, follow-up appointments will be scheduled so that your radiation oncologist can make sure your recovery is proceeding normally and can continue to monitor your health status. Your radiation oncologist may also order additional diagnostic tests. Reports on your treatment can be sent to your other doctors.
As time goes on, the frequency of your visits will decrease. However, you should know that your radiation oncology team will always be available should you need to speak to someone about your treatment.
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