Radiation treatment — Wellington, Hutt and Kapiti

You may need to attend a planning appointment or several pre-assessment appointments before your treatment.

If brachytherapy is your only treatment with us, you will receive a letter telling you when your appointments are.

On the day of your first appointment, come to the reception of the radiation treatment department on level 2 of Wellington Regional Hospital.

You will talk to the radiation oncologist in charge of your treatment and meet a brachytherapy radiation therapist. This is a good chance to ask questions about your treatment. We will do a series of tests to make sure you are able to have brachytherapy.

These tests may include:

• CT/MRI scan
• anaesthetic assessment
• bladder function tests
• blood tests.

You are welcome to bring a support person.

You will be awake during your treatment. If you are receiving prostate brachytherapy or a prostate biopsy, you will be asleep.

Applicators will be placed in your body to deliver the treatment. The applicators are attached to the brachytherapy machine.

The process for inserting and placing the applicators is different depending on the site being treated.

Your treatment team will leave the room while the treatment is being delivered, but will monitor you by camera.

Radiation will travel down the tubes into the applicators. You will not feel anything from the radiation while the treatment is being delivered.

After your treatment is complete, your radiation therapist will confirm that the radiation levels in the room have returned to normal.

You will not be radioactive after treatment and will be able to have contact with people as normal.

Planning appointments

Before you start radiation treatment, you will have a planning appointment.

At this appointment, you may have a computed tomography (CT) scan, or the doctor may draw the area they wish to treat on your skin. Radiation therapists and doctors will use the information gathered during this appointment to plan your treatment.

You may also receive another form of treatment along with radiation therapy, such as chemotherapy or surgery.

Preparation for your scan

You may have been sent, or given instructions by phone, to prepare for your planning scan. It is important to follow these instructions.

If you have been unable to follow this advice, tell your radiation therapist.

If you are unsure about what you need to do to prepare, call 04 806 2000 and ask to speak to the planning department.

Making a mask (shell)

We may make a mask for your planning scan and your treatment if we are treating your:

• head
• neck
• throat.

Your head is very mobile and difficult to keep still, so we use a mask to help you keep it in the right place for treatment.

The video below has more information about having this treatment. Part of the video goes through how we make the mask for you.

Head and neck cancer treatment info — YouTube

CT scan

On the day of your scan

When you arrive at Wellington Regional Hospital check in at the reception of the radiation therapy department on level 2. A radiation therapist will come to meet you in the main waiting room and take you and your support people into a clinic room.

They will explain what is going to happen and make sure you have all the required information. This is usually a good time to ask any questions. You may have been asked to follow some instructions in preparation for your scan. It is important to tell them if you have been unable to follow this advice.

Once everything has been explained, they may ask you to get changed into a gown or trousers, depending on what area of the body we are scanning. They will give you a basket to put your belongings in while you have the scan.

Having your scan

The radiation therapist will show you into the CT room. Your support people are welcome to join you, but will be asked to leave when you have the scan. You will be asked to lie down on the CT couch in a position as comfortable as possible and we will plan your treatment. This is the same position you will be in for your treatment so if it is uncomfortable let the staff know.

The radiation therapists will move you into the right position for treatment by using laser lights. Then they will draw some pen marks on your skin. These will wash off. They will also place some markers on your skin, which will come off at the end. They will then move you through the scanner. Once you are in the correct position, the radiation therapists will tell you they are leaving the room.

While the radiation therapists are out of the room, they can see and hear you at all times. If you need them, call out or wave, and they will come back in. You will move through the centre of the scanner a few times during the scan. While you are having your scan, you will not be able to feel or see anything, but you will hear a whirring noise when the scanner is on. Once you have had the scan, the radiation therapists will come back into the room and take a few more measurements. They may then ask you if they can make some permanent tattoo dots on the skin or cover your marks with plastic tape.

Tattoo dots

Sometimes we need to make small dots on your skin to guide your treatment. These are permanent. A radiation therapist will wipe your skin with an alcohol swab, place a dot of ink onto the skin surface, then using a sterile needle they will push a tiny amount of ink under your skin. They will wipe off any excess ink leaving a tiny permanent dot on your skin. This will not wash off.

Not all patients need tattoo dots, in some cases plastic tape is used to keep the marks on your skin. This tape is not permanent but we hope that it will last until you have finished treatment. Let us know if you are allergic to plasters.

Consent

After you have had your scan, you may see your consultant or registrar. This is so they can give you all the information you need to consent to treatment.

This is a good time to ask any questions you may have about treatment. Questions often come up after you have seen the doctor, so write these down and bring them to your next appointment.

Questions to ask your doctors — Cancer Society

The doctor may give you a prescription for medication you need to take before treatment. It is important to go to a pharmacy and fill your prescription before you start treatment. Let the doctor or a member of the team know if you cannot get to a pharmacy or if you cannot afford the prescription.

Creating a treatment plan

You do not need to come to the hospital for the next part of the planning process. Your consultant and the radiation therapists will use the information from your scan to plan your treatment.

Once your plan is created, it is checked to make sure it is correct by the:

• radiation therapists
• doctor
• physics department.

It will be checked again by the radiation therapists on the treatment machine before treatment starts. This part of the process can take 2 hours or up to 2 weeks, depending on how complex the treatment is.

Once your plan is complete, you will be called, or sent an appointment in the post, with the date you will start treatment. The rest of your appointments will be given to you on the day you start treatment.

If you do not receive details of your appointment, call us on 04 806 2000

On the first day of your treatment, come to reception at the radiation treatment department on level 2 of Wellington Regional Hospital.

Your treatment appointments

Your treatment plan includes several radiation sessions. You will generally spend 15 minutes each day in the treatment room.

When you arrive each time, check in at reception and come through to the treatment area.

Your treatment will be delivered using a linear accelerator machine. Get changed if you have been told to and wait until the staff call you through.

A radiation therapist will take you into the treatment room. Your support people are welcome to come in after the first day. You will be asked to lie down on the couch and will be positioned as you were at your planning CT appointment. If you had a mask made for your CT scan, you will be asked to wear this.

The radiation therapists will then move you and the machine into the right position using the plan that was made for you. They will draw around your tattoo dots (if you have them) and dim the room lights so they can use laser lights to help make sure you are in the right position. It can feel a bit funny being moved around.

They will also take some x-ray images to check you are in the right position. There are parts of the machine that come out to enable the treatment staff to take these images. Do not be alarmed if you feel the couch move after the images have been taken — this is being controlled by the radiation therapists.

Once you are in the correct place, they will move the machine around you. From now on, you will need to stay as still as you can. They will check that the machine is set correctly and tell you when they are ready to leave the room. You will hear a bleeping noise as they leave and may hear a door closing. While the radiation therapists are out of the room, they can see and hear you at all times. If you need them, call out or wave, and they will come back in.

When you are having treatment, you will not be able to feel anything, but you may see the machine moving and hear a buzzing sound. Even if you think the treatment has finished, stay in the same position until the radiation therapist has come back into the room and tells you it is ok to move.

Before your superficial x-ray treatment, you will need to attend a 30-minute planning session.

• A doctor will draw marks on your skin with a felt-tip pen. This marks the exact area to be treated.
• A radiation therapist will take photos and make reference templates. This is so your care team can plan your treatment. All pen marks will be wiped off at the end of the appointment.

The radiation therapist will also tell you about your treatment appointments and provide advice on how to care for your skin during treatment.

During treatment, you will lie on a bed and the superficial x-ray machine will sit gently on your skin. Treatment time depends on the area being treated, but is usually about 2 to 3 minutes. You will need to stay still while treatment is given.

Treatment is painless. You will not see anything or feel any sensation while the x-rays are on, but you might hear a buzzing noise coming from the machine. You will be in the room by yourself while the treatment is delivered.

The radiation therapists can see and hear you the entire time. If you need anything, call out or wave, and they will come back in.

Reactions from superficial x-ray treatment usually peak about 2 weeks after treatment —most people find that side effects begin to ease after about 2 to 4 weeks.

Continue to follow the advice given by the radiation therapists until any reaction has subsided.

The skin in the treated area will always be more sensitive to the sun. Keep the area covered as much as possible and use sunscreen with a sun protection factor (SPF) of at least 30.

A radiation oncologist is a doctor who specialises in:

• looking after patients with cancer
• treating cancer using radiation therapy.

A radiation oncology registrar is a doctor who is currently training to become a specialist.

These doctors will oversee your radiation therapy treatments.

The radiation oncologist is responsible for assessing you and deciding whether radiation treatment is required, as well as the number of treatments needed. They work with other cancer specialists to come up with the best treatment plan for you.

Specialists include:

• surgeons
• medical oncologists (chemotherapy doctors).

The radiation oncologist also works with the other members of the radiation treatment team to plan your treatment.

Your radiation oncologist will monitor your progress while you are having treatment and assess any side effects. After treatment has finished, you will have a follow-up appointment and they will assess how you are.

The radiation oncologist and the registrar work closely together.

Radiation therapists plan and deliver your radiation treatment. They will assess you before each treatment.

Let them know if you have any problems or difficulties. They can offer advice or contact other members of the treatment team if needed.

The radiation oncology nurses usually meet with you early in your treatment to discuss your health needs and how you can look after yourself during and after your treatment.

They work closely with your doctors and radiation therapists to help you manage any side effects from treatment.

Radiation oncology nurses:

• give medications and intravenous fluids when needed
• dress your wounds
• offer assessments and advice.

They can also contact community oncology nurses if you need extra support at home.

Physicists play several important roles in the radiation treatment department.

They are involved in calibration and quality control of the treatment machines and work with the doctors and radiation therapists to achieve the best treatment plan for you.

This means they will be present sometimes at planning and treatment appointments.

Healthcare assistants help patients around the department and can help you get changed for treatment. They often help radiation therapists and nurses move patients from beds to the treatment couch and take care of people using the day beds in the radiation treatment department.

A cancer diagnosis is not just a medical event. It brings changes to the way you and your whānau live.

Our oncology social workers can:

• talk to you about the changes that your diagnosis has had on your life
• support you in accessing services that can help you manage them.

They can also provide counselling and emotional support if you are feeling anxious, down or worried about:

• your health
• your whānau
• the future.

If you would like to speak to an oncology social worker, ask a member of your radiation treatment team to refer you.

Our reception staff welcome all patients and visitors to the radiation treatment department.

They will check you in for your appointment and guide you to the part of the department you need to be in.

Reception staff can help with:

• booking appointments
• travel and accommodation arrangements
• updating your contact details.

They also keep the refreshment counter well stocked for you to enjoy.

If you are unsure about anything, ask at reception and they will be able to help you find the right person to talk to.

Dietitians are experts in food and nutrition. They can advise you and your whānau on what to eat throughout to maintain a healthy diet during your treatment.

A speech-language therapist may see you during and after treatment. They will assess what support you need and can advise you on:

• swallowing
• voice quality
• speech.

They may give you exercises to perform.

Wellington Regional Hospital is a training centre for students from the University of Otago. Radiation therapy students study for 3 years at the university and do on-the-job training. Usually, the Blood and Cancer Centre will have 3 students working in the department. They are easily recognisable by the university logo on their uniform. They are an important part of the radiation therapy team.

You may be asked if you are willing to have a student involved in your care. Although it is very helpful when students can be involved, you have the right to refuse student involvement at any time. Radiation therapy students are always directly supervised by a qualified radiation therapist, and there will only ever be 1 student present at a time.