St. Joseph Health System
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Steps to Treatment

Consultation
After a brief medical assessment by the nurse, the patient will meet with the radiation oncologist to discuss the use of radiation therapy in treatment. During this visit, a detailed history and physical exam will be performed by the doctor.

If radiation therapy is recommended as a part of the treatment, the physician will review in detail the proposed treatment, the reasons for recommending the treatment, and the potential risks and side effects of such treatment. Ample time will be provided so that the patient has a full understanding of the treatment and related issues and all of questions and concerns have been answered in full.

Once a patient has a full understanding of the proposed treatment, risks, side effects, and other possible treatment options, a consent form will be signed. Even after the consent form is signed, the doctor is always available to answer new questions or to provide additional information. Patients can withdraw a consent at any time for any reason.

Simulation
Once the decision has been made to give radiation treatments, an appointment will be made for the patient to return for a marking session.

Patients are positioned on the simulation table to determine the treatment area. It is very important that whatever position the patient is in on that day is the same position that will be reproduced on a daily basis. In some cases, contrast media may be used to help better visualize important structures for the treatment planning process. The simulation technologist and/or the radiation therapist, under the supervision of the radiation oncologist, will define the treatment ports or treatment fields. This is the area that will be treated with the radiation and will be marked with permanent ink dots.

Following the simulation, a CT Scan will be performed only in the area of the body that was marked. These scans produce a 3-D image of the tumor to help in planning the dose that will be delivered to the normal structures in order to deliver the prescribed dose to the cancer.

*** Upon completion of the simulation/CT, an appointment will be made for you to return for your verification day. ***

Treatment Planning
The process of planning radiation therapy is complex and may take several days to complete. It is, however, one of the most important parts of radiation therapy. The Dosimetrist, along with the Radiation Oncologist, will design a treatment unique to each patient that will give the strongest dose of radiation to the cancer while sparing as much normal tissue as possible. This will help reduce the side effects that can be experienced.

Treatment Plan Verification
On verification day, the radiation therapists will properly align the marks that are on the patient's skin. Once in the correct position, x-rays are taken and compared to the x-rays that were taken on simulation day. These x-rays also show the shape of the treatment field that are made with custom blocks of multileaf collimation. If any adjustments need to be made, they are done so at this time. No radiation is given on this day, unless specified by the radiation oncologist.

Daily Treatments
The radiation therapists will assist the patient to the treatment room, onto the treatment table, and gently move the patient to position the body as to duplicate the treatment position.

The therapists work together as a team and may talk to teach other during this important process of moving and guiding the patient through the treatment position. The immobilization devices that were custom made during the simulation procedure will be used to help duplicate the treatment position and keep the patient from moving during the treatments.

Once correctly positioned, the therapists will leave the room to begin the radiation treatment. Treatment is not painful and will not cause any immediate reactions. The length of time it takes to treat will depend on the patient's individual treatment plan. Treatments are given Monday through Friday. Appointments are given by radiation therapists who operate the treatment unit.

Weekly Visits During Treatment
On a weekly basis, a nurse and a radiation oncologist will monitor progress during the treatment and answer any questions that may arise.

Allow for additional time in your schedule for these activities and remember to write questions down so that they'll be ready for each visit with the doctor. The therapists and nurses will be available to answer any questions they can at any time. Lab work will be taken every other week.

Follow-Up Appointments
When treatment course is COMPLETE, the radiation oncologist will determine a follow-up schedule. 

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