Your Radiotherapy Treatment

Coming for Treatment in Shrewsbury

Radiotherapy treatment can start on a weekday generally a few weeks after planning CT scan has taken place. Treatment appointments normally take between 10 and 30 minutes. On your first day of treatment, a member of the team will come and collect you from reception, and show you round to the treatment areas. They will sit down with you, and explain what will happen during your appointment, and it is another opportunity to ask any questions you may have. On subsequent visits you will be called to the treatment units via an intercom. If there is a problem with being called in this manner, please let the team know and we will work out an alternative.

Patients are asked to bring and change into a gown each day for treatment as clothing will need to be removed in the treatment area.

Your Treatment

When attending for treatment, you will be asked by the radiographers to stay as still as possible so that the treatment can be given to the correct place. No-one else can stay in the room with you whilst the machine is on but the radiographers that are operating the machine outside are watching you on cameras and can hear you at all times. If for any reason you need the radiographers, we ask you to raise a hand and the radiographers will immediately stop the treatment and enter the room. You cannot feel the radiotherapy treatment being delivered, but may feel the bed moving and be aware of a buzzing or beeping noise in the room, when the machine is switched on.

Your journey begins with a Planning CT Scan

When you are referred for Radiotherapy, a Radiographer will be in contact to arrange a CT planning scan. This is to enable the Dosimetrists and Oncologists to plan your treatment carefully and specifically for you. At the scan, you will have an opportunity to meet some of the staff and ask any questions.

During the CT scan, the radiographers will put small dots on your skin using a special felt pen. At the end of the session the radiographers will have asked your permission to make these marks permanent by tattooing very small dots. These are necessary to ensure your treatment is delivered accurately each day. Depending on the area of the body treated, you may be here for around 30 to 45 minutes, but sometimes this can be longer.

Depending on the area being treated a Positron Emission Tomography (PET) scan and Magnetic resonance Imaging (MRI) scans may also be required for the planning of your treatment. These will be performed by our colleagues in the diagnostic radiology departments and you will either be contacted separately in order to arrange appointments.

The information from the CT scan is sent to the Physics department who work with your Oncologist to plan your treatment.

Treatment Planning

Your CT scan is used to produce a personal treatment plan all of which needs to be checked and transferred to the treatment machine.

Your Oncologist will review the images from your CT scan and draw on each slice to show exactly where the treatment needs to be. They will also draw around structures where the dose needs to be kept as low as possible. This is so that we can keep side effects to a minimum.

Once this is done, a Dosimetrist will plan your treatment. There are a number of different types of treatment available so the Dosimetrist and your Oncologist will decide which one is most appropriate for you. The plan is then checked by a physicist who ensures it is correct, safe and ready for your treatment.

Types of Treatment used in Shrewsbury

This is a type of treatment that uses a Linear Accelerator.

The dosimetrists can plan the radiotherapy treatment area very precisely in 3 dimensions – width, height and depth. The radiotherapy beams are shaped to fit the treatment area very closely.

They make sure that the entire tumour is inside the radiotherapy field and healthy tissue is avoided as far as possible. This reduces the risk of side effects.

This is a type of is a type of conformal radiotherapy that uses a Linear Accelerator.

This treatment gives high doses of radiation at very specific parts of a tumour. Each radiotherapy beam is divided into many small beamlets that can vary their intensity. This allows different doses of radiation to be given across the tumour. In this way we can create a very conformal treatment which deliver a much lower dose to healthy tissues and reduce long term side effects.

Volumetric Modulated Arc Therapy (VMAT) is a type of IMRT and also uses a Linear Accelerator.

This is very similar to IMRT. During this treatment the linear accelerator rotates around the patient continuously delivering the treatment. The machine reshapes and changes the intensity of the beam as it moves around the body. Giving the radiotherapy in this way shortens the treatment time.

We have 3 “state of the art” Linear Accelerators here at the Royal Shrewsbury Hospital.

Each of our Linear Accelerators has on board imaging. This means that we can take X-ray images of you in the treatment position to help with ensuring that we are set up accurately. They can also take CT images of you in treatment positions. These are known as cone beam CT or CBCTs and allows us to offer Image Guided Radiotherapy (IGRT) to you.

Review

You will be reviewed once a week by a Review Radiographer who will check up on how you are doing, offer advice and answer any of your questions. If at any time you need to speak to a Radiographer please do not wait until it is time for your review, all the radiographers will be happy to help or to find the help you need.

During your Radiotherapy it is important to keep hydrated and drink plenty of fluids; it will also help if you can keep active. At the Royal Shrewsbury we have Macmillan “Get Active Feel Good” who can guide you through an exercise regime tailored to your needs. They can be contacted at getactivefeelgood@gmail.com or by phone: 0754 3827531.

It is possible that there will be times when you will have to wait for treatment, this may be due to other patients taking longer than anticipated, or because of a machine issue. As you may be here for some time, it would be advisable to bring any regular medications with you for example pain killers.

After Radiotherapy has finished

Once your treatment is completed, the acute side effects may continue for a few weeks even though you are no longer receiving treatment.

If the side effects persist, then you should continue with the advice that you were given during radiotherapy until the side effects stop. If unsure of what to do, please contact us on 01743 261179 and leave a message, we will get back to you with advice as soon as we can.

Most patients will be seen by their consultant 6-12 weeks after the end of treatment. This appointment will be at the hospital where you originally saw your Oncologist. If an appointment is not received in the post within this time please contact the department.

Our department is located on the ground floor of the Lingen Davies Centre at the Royal Shrewsbury Hospital.

As you enter the main entrance to the hospital continue along the road until you see the helipad and A & E services, the Lingen Davies Centre is just pass this on your left.

Parking is available directly across from the department and patients receiving treatment here can claim free parking, all you have to do is give your details to reception on arrival.

The Hospital is serviced by the regular number 11 Arriva bus service from Shrewsbury Town Centre bus station.

If you are diabetic, you should ensure you bring your insulin and some food each time you attend for radiotherapy treatment, just in case there is a delay. Please inform one of the treatment radiographers if you are diabetic.

Head and Neck patients will be seen by Dieticians and Speech and Language Therapists. Please see below for a short film of our advice.

Dieticians are experts at assessing and treating a wide range of nutritional issues that can develop as a result of cancer and its treatment. Speech and Language Therapists are experts at assessing and treating any speech, voice or swallowing problems that you may have as a result of the cancer, surgery or the treatment.

If you require our input you will meet us either before you start radiotherapy or in the first week of your treatment. A referral can be made to us by a registered health professional. Together with our Assistant Practitioners we will aim to review you weekly through your treatment. But if you have concerns at any point let us know and we will try and see you sooner. At your initial assessment we will ask you questions about what you normally eat and drink and your weight.

It is helpful for us to understand your usual eating pattern and food preferences, and we will identify any problems you have that are making it difficult to eat. This is so we can give you advice to improve your nutrition. We will also provide you with information about managing the side-effects of the treatment. Nutrition is very important before and during your treatment. We aim to maintain your weight from the start of treatment until you have recovered. Good nutrition will help you cope with the radiotherapy, can reduce the severity of side-effects and will help your recovery afterwards.

Head and Neck patients can contact their Clinical Nurse specialists at sath.headandnecknhs@nhs.net

or 01743 261000   ext 3902

All Breast cancer patients are invited to a group pre-assessment before they start their radiotherapy journey. At this meeting you will see a presentation about what to expect during your treatment and the team will talk to you, individually, about any issues you may have before you come for you CT planning appointment. Your doctor may have spoken to you about a technique called Deep Inspiration Breath Hold (DIBH), if this is so we recommend that you practice holding your breath for 30 seconds before you attend for your CT appointment, as for treatment you will need to be able to hold your breath.

See below for a short video of the patient journey through our department.

All Prostate cancer patients are invited to a group pre-assessment before they start on their Radiotherapy journey. At this meeting you will watch a short film explaining what happens when you come to the department. The main message from the film is to increase your daily fluid intake of water/squash to at least 2 litres over a normal day. This is in addition to any other drinks you may have.  This is very important so that your body is hydrated so that when you start ‘your treatment’ you will have a nice full bladder at CT and throughout treatment. Having a comfortably full bladder will help to minimise potential side effects caused by the radiotherapy treatment; as by being full it is lifted up out of the treatment area. You will also be given an enema which you will use on a daily basis whilst in the radiotherapy department.

It is really important to follow the advice you have been given regarding drinking at least 2 litres of water/squash, (not fizzy drinks). It is also important to eat regularly, as going long periods without food can cause gas to build up in the rectum. It might be useful to bring a small snack with you when on treatment, just in case there are delays in the department etc.

When you attend for your CT planning scan, additional scans are taken to measure the rectum and the bladder; if either of these do not meet our requirements you will be sent home with further instructions and a new date for your CT planning scan. This could delay the start of your treatment.

Some patients may have contrast (a dye) injected, this will not apply to everyone and your Consultant will have informed you if he wanted to use contrast for your scan.

Daily Bowel and Bladder preparation whilst on treatment, a few pointers:

  • Use enema and empty bladder
  • Once enema has worked, check into reception
  • Wait to be called to the treatment area
  • Try to empty bladder again
  • Drink allocated amount of water (decided at CT)
  • Write down the time you have finished ALL your water

DO NOT EMPTY YOUR BLADDER AGAIN, BUT IF YOU NEED TO INFORM A MEMBER OF STAFF.

Please see below for a short video of the patient journey through our department.

For some treatments we create a device called an ‘immobilisation shell’, which is placed onto your body both for planning and treatment. This is most commonly needed for radiotherapy to the head and neck or limbs

Its main purpose is to help you to stay still ensuring your position is reproducible and your treatment is accurate. It also means we can place reference and marks onto the shell rather than your skin. A sheet of thermoplastic net is heated in warm water for 2 minutes to make it soft and stretchy. When placed on your body it takes the shape of the treatment area as it cools, this takes 15 minutes and you may have your CT scan while your shell takes shape.

Please see below for a short video about the making of a shell.

Once your shell has been made you are ready to start your CT scan. Please see below for a short film about the patient journey for Head and Neck patients.

To contact your Oncologist via their secretaries please call: 01743 261000 then the relevant extension number.

Dr. Pettit & Dr. Khanduri

Secretary          ext:1334
Support Sec.      ext:2579

Dr. Srihari & Dr. Prashant

Secretary          ext:1656
Support Sec.    ext:2375

Dr. Zachariah

Secretary          ext:1103
Support Sec.     ext:2413

Dr. Chatterjee & Dr. Dhinakaran

Secretary          ext:1106
Support Sec.    ext:2411