Patient pathway

Consent

Following a cancer diagnosis, the next step will be to see the oncologist. In this encounter, the oncologist will explain your diagnosis and the radiotherapy procedure. They will also explain the side effects of radiotherapy treatment and it is in this appointment the oncologist will consent you for treatment.

Once consented, you still have the right to change your mind at any time. The oncologist will also give you your planning CT scan appointment date and time or tell you to expect a call from the CT department team to arrange.

CT planning scan

In order to plan your radiotherapy treatment, most patients will need to have a radiotherapy planning scan. Slightly different to a regular diagnostic CT scan, the radiotherapy planning scan creates 3D images of the area being treated which enables us to create a radiotherapy plan tailored to the patient.

This appointment will often be the first time you will come into contact with a radiographer; first off they will explain the CT scan procedure to you and confirm your consent for the scan. The scan for most patients typically takes between 15-20 minutes. However some scans require additional preparation meaning some appointments can take up to 2 hours. Some patients will also need an injection of contrast agent during the scan itself which helps highlight important areas the oncologist may want to treat or avoid.

During the scan, the radiographers will record measurements which will be used for your radiotherapy treatment. The radiographers will also be making small pen marks on your skin; if the scan is successful, with your permission they will make these marks permanent with small tattoo dots. These permanent marks enable you to wash as normal during the course of your treatment and are used by the radiographers to set you up for your treatment.

Following a successful scan, most patients will be given their treatment start date. Depending on the treatment area and the complexity of the treatment plan required, this can be up to 4 weeks from your scan.

Radiotherapy treatment

Radiotherapy treatment uses high energy radiation (usually photons or electrons) to treat disease. These high energy rays destroy cancer cells; normal cells can also be damaged by radiotherapy but can usually repair themselves, whereas cancer cells can’t. Radiotherapy treatment is carefully planned in order to avoid as much healthy tissue as possible, however some healthy tissue will be affected which will cause side effects. Before you start treatment, your oncologist will discuss the side affects you may develop; this is usually done at your initial consent appointment.

Treatment itself is most commonly delivered using external beam radiotherapy. Radiation is given using a large X-ray producing machine called a linear accelerator or linac. Treatment is delivered by at least two therapeutic radiographers and typically takes between 10-15 minutes; treatment can sometimes take longer depending on the area being treated. The radiographers will set you up into your treatment position using the permanent dots you had put on following your CT scan. Once the radiographers have checked a few more measurements they will leave the room to start the treatment.

When outside the treatment room the radiographers are watching you for the duration of the treatment and you can communicate with them at any time, it is important for you to stay as still as possible for the treatment. Often the radiographers will take X-ray pictures of the area being treated and some surrounding anatomy to ensure the radiation is being delivered to the right area. If everything is ok they will then deliver the radiation treatment, this is a relatively quick process and usually last no longer than 2 minutes, this can vary depending on the area being treated.

Once treatment is complete the radiographers will come back into the room and get you off the treatment couch, you are then free to leave the department and will be seen again at your next treatment appointment, typically treatment is given once a day, Monday to Friday with a rest at the weekend. Radiotherapy treatment does not make you radioactive and you are okay to carry on as normal.