Patient pathway


Following a cancer diagnosis, the next step will be to see the clinical oncologist. In this encounter, the doctor 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. At this point you will also be given written information about your radiotherapy 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 therapeutic radiographer. The CT scanning process will be explained to you and you will have the opportunity to ask any questions.. The CT scan typically takes 15-20 minutes. However, some scans require additional preparation meaning the 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 make small pen marks on your skin;and  with your permission tthese will be made into 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 in the correct position for your radiotherapy treatment.

Following the CT 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 effects 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 the appointment typically lasts about15 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 at your CT scan. Once the radiographers have confirmed that you are in the correct position they will leave the room to start the treatment.

When outside the treatment room the radiographers are watching you via CCTV for the duration of the treatment and you can communicate with them at any time via an intercom, it is important for you to stay as still as possible for the treatment. Before starting your treatment,  the radiographers may take x-ray pictures of the area being treated and some surrounding anatomy to ensure the radiation is being delivered as accurately as possible. They will then deliver the radiotherapy treatment, There is nothing to feel or see whilst the radiotherapy is being delivered. 

Once treatment is complete the radiographers return to the room and help you off the treatment couch, you are then free to leave the department. 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 should carry on as normal.