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All About Radiation Therapy

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Joel W. Goldwein, MD
Abramson Cancer Center of the University of Pennsylvania
Last Modified: October 24, 2006

This is a pictorial view of the pediatric patient's flow through the Department of Radiation Oncology at the University of Pennsylvania. While this document is directed at children undergoing radiotherapy at the Hospital of the University of Pennsylvania, many of the procedures are very similar for adults at other institutions.

Getting to Know Your Doctor

For your first visit to the Radiation Oncology Department, you and your parents will meet with your doctor in order for all of you to get to know each other.

During this first visit, the doctor will examine you and also inform you about the radiation therapy process and all you need to know about the actual treatment.

The Simulator

	On your second visit to the hospital, the planning for the treatment will begin. Sometimes, a special scan will be performed, but usually an x-ray will be taken of you while you lie under a big machine known as a "simulator." This process is therefore called simulation.
	After the x-rays are developed, the doctor will examine them and then he will mark them in the places where you will be receiving treatment. This X-ray like photo is taken so that the doctor(s) can map out exactly where the tumor is located and where you must receive your treatment.
	Sometimes, tattoos will be made to mark the edge of the radiation therapy field on your skin. The first step in making a tattoo is to place a drop of ink on the skin.
	The ink spot will be scratched with a sticky needle to draw the actual tattoo.
	This is what a complete tattoo looks like and this tattoo marks the spot where the radiation beam will be pointed. The tattoo stings for a second, but they are much easier than a finger stick or a needle.
	A few days later, a set-up is done with you on the treatment machine by the doctors and the technicians. This is done to make sure that the treatment will be delivered exactly as designed during simulation. This set-up may also be based on computerized treatment planning to determine the best way to deliver the radiation as prescribed by your doctor.
	Objects called "blocks" are sometimes made just for you. They are used to separate the cancerous cells from the normal cells so that they will not affected by the radiation beam. After the blocks are made and are slid into place on the machine, actual treatment can begin. You will be laid on a table of a big machine known as the linear accelerator. This machine will be moving over and around you and this is so that it can aim itself directly at the tattoo. One thing to remember is that you have to be very still while the machine is on so that the wrong parts of your body will not be affected by the beam. The laser beam on this patient's back is used to help line up the patient from one day to the next.
	This is a picture of a simulation film compared to a portal film usually examined at the time of set-up on the treatment machine.
	The doctors and technicians will leave the room while you are receiving your treatment so that they will not be unnecessarily exposed to radiation. They will be right outside of the door and they will be watching you on a television screen outside the room. There is no pain or sensation with these treatments. It is just like getting a picture taken!

For a period of time, you may have to come back everyday to receive your treatment. After your treatments are over, you will have to come back to the hospital for something called followup examinations. This is where the doctor checks you out to see how the radiation treatment has affect you and how well you are doing. The doctor does stress close follow-ups for all patients who have undergone treatment with radiation. Follow-up intervals will range from once every week to once per year, but they are very important and you should be present every time one is scheduled.

One thing that you should really try to remember is that all of the nurses, technicians, and doctors are here to help you in the best way they can. They have your best interests at heart and they are eager to see you get well.

Hopefully, this pictorial display has given you a much better understanding of the radiation therapy process. If there is still anything you don't understand or are really confused about, ask your doctors and they will answer your questions in the best way that they know. Remember, these are not just people in white coats, they are your friends.