Your consultant will discuss which treatment regime is best for you at your clinic appointment and may go into some detail about what to expect when you attend for your planning CT scan and radiotherapy treatments. Depending on where on your body you are having treatment, the 'planning' stages will vary.

See the tabs above for a general summary of each stage of your radiotherapy treatment.

What we do

As we are one of the specialist centres in the South West we provide a wide range of specialist treatments, including treatments for paediatrics and adolescents; total body irradiation, stereotactic ablative radiotherapy (SABR) and chemo-radiation. The machines used to deliver these complex treatments are Elekta linear accelerators. The following are some of the specialist treatment techniques used:

IMRT

Intensity-modulated radiation therapy (IMRT) delivers an advanced type of high-precision radiotherapy by shaping the radiation beam to closely fit the treatment area and by modulating or conforming the intensity of the radiation beam. This causes different doses of radiation to be given across the tumour, ensuring the best possible coverage of the treatment area. The shape of the beam is achieved by using several thin fingers of lead which move independently of each other called multileaf collimators (MLC's) and are found within the head of the machine.

IGRT

Image Guided Radiotherapy (IGRT) is the use of advanced imaging techniques to verify your position and anatomy before, during and after your radiotherapy treatment. This ensures the treatment is being accurately delivered to the treatment area. CBCT (cone beam CT), KV (kilovoltage) imaging and ultrasound are used to take these images while you are in the treatment position.  The images are reviewed by the radiographers who then apply movement corrections, via the treatment couch, that account for twists and tilts in the body, changes in body weight and organ motion so we can accurately and safely deliver your treatment. Using IGRT reduces the radiation dose to the healthy tissue therefore minimising side effects.

VMAT

Volume Modulated Arc Therapy (VMAT) is a type of IMRT which allows the high energy X-rays to be conformed to the shape of the tumour whilst ensuring that the dose to your surrounding tissues and organs is as small as possible by using MLCs. By using this treatment technique, we can vary the intensity and shape of the treatment beam. It allows us to treat the tumour from many different angles in one circular motion. VMAT treatments are very quick to deliver, meaning that you should be on the treatment bed for a shorter length of time. At the BHOC we routinely use VMAT when treating pelvic areas, lungs, chests, brains and head and neck cancers.

SABR

Stereotactic Ablative Body Radiotherapy (SABR) has been used as a specialist treatment technique in Bristol since November 2013. SABR treatments are typically delivered using the same VMAT delivery technique mentioned above. SABR delivers a very high dose to a very small tumour volume. Due to the high dose delivered in each treatment, IGRT plays a vital role in this technique. Cone beam CT scans will be taken by the treatment machine and assessed before and during each treatment to ensure you are in the correct position to accurately deliver your treatment.

SABR can be used to treat different areas of the body including lungs, liver, lymph nodes, spine and small areas of bone. Each case is considered on an individual basis as the criteria for SABR is very restrictive. Your consultant will discuss with you if you are having SABR treatment.

Clarity

Clarity is the use of live imaging of the treatment area and other anatomy using an Ultrasound scanner for some prostate treatments. Clarity monitors the intra-fractional motion (movement inside the body that cannot be controlled) of the prostate and surrounding organs. The Clarity system enable us to precisely manage intra-fraction motion during the treatment beams, providing gold standard prostate treatment.

With Clarity, we can see and monitor soft-tissue anatomy i.e. the prostate-without needing extra imaging such as cone beam CT scans or surgically inserted markers. The benefits of clarity include providing better visualisation of the prostate, it is a non-invasive technique, it can be used alongside our already existing IGRT protocols and once set up carries out automatic scanning throughout each treatment.

ABC

Active Breathing Coordinator (ABC) provides the non-invasive immobilisation of certain internal anatomy which is affected by respiratory motion (breathing), such as the lungs, liver or pancreas. This is achieved through a simple and efficient assisted breath-hold technique. ABC is used alongside VMAT and IGRT to enables us to deliver your treatment to the area with confidence and accuracy. The benefits of ABC is it immobilises the area for treatment by restricting movement of the diaphragm and temporarily pauses breathing, it allows for higher dose delivery when using techniques such as SABR and it reduced the dose to the healthy tissues therefore minimising side effects.

If you are having ABC as part of your treatment you will attend the department for a coaching session which allows you to practice with the equipment under the guidance of a specially trained radiographer. You will then use the ABC system all the way through your treatment.

Before you start your treatment, you will have a planning CT scan. This is so the treatment area can be outlined on your scan with you lying in the treatment position.

For the CT scan you may be asked to remove certain items of clothing and given a special gown to wear. Although part of your body may be exposed, the pre-treatment radiographers will cover you up as much as possible.

The treatment position may vary depending on which part of your body is being treated. If you are suffering from any aches and pains, please take some pain relief (as prescribed on the label) prior to your scan as you may be lying on the couch for some time. The consultant may request for you to have an injection of some special dye (contrast) during the scan. This contrast enhances your images but is not required for all treatment sites or necessary for the planning of your treatment if you are unable to have it please do not worry. If you do have an injection of contrast during your scan it may make you feel hot and like you need to urinate but this will be temporary.

At the end of your scan, with your permission, small permanent marks (tattoos) will be put on your skin in the treatment area. These are no bigger than a freckle and help the radiographers to get you into the same treatment position daily, making your treatment more accurate. Your consultant will mention these tattoos to you at your clinic appointment. 

Some people may also require extra appointments on the day of their planning scan which takes place in the mould room or may have some breathing coaching prior to their CT planning scan. This will be indicated on your appointment list or you will be informed over the phone if the radiotherapy bookings team call you with your appointments. Normally people who are having their head, neck, chest or limbs treated will have these extra appointments.

The radiographers you meet at these appointments will explain in detail about what will happen so please feel free to ask any questions you may have.

Once your CT planning scan is complete you are free to go and will return at a later date for your radiotherapy.

Your appointment list will usually be sent to you by post in advance of your CT scan but if you have not received anything please contact the radiotherapy bookings office. Their details can be found in the contact us section of the website.

After you have had your scan the images are sent to our radiotherapy planning software. From here your consultant will outline the area which needs to be treated and any other organs which may be in the same area. These are known as 'organs at risk' (OAR). Once the outlining has been completed the radiotherapy planning team use a very complex and advanced planning system to plan your treatment. Everybody has their own individual plan for their radiotherapy treatment. When the plan is finalised it is checked and signed off by the consultant and two medical physicists ensuring the best possible treatment plan for you. 

Calculation room

Once the plan has been finalised and signed off it is sent to our calculation room which is run by the radiographers. Here, the plan is checked again and all the necessary information and images are imported to our radiotherapy treatment system ready for you to start your treatment.

On the first day of your radiotherapy, you will have a 'first day chat' prior to your first treatment appointment. In this chat you will meet one of our radiographers who will go through the treatment process, confirm your consent and answer any questions you may have.

When you enter the treatment room the radiographers will ask you to confirm your date of birth, address and which part of your body you are having treatment to ensuring the right person is in the room. Please also bring your appointment list with you each day as your unique hospital number or T number on the top of your list is checked as another form of identification. Once on the treatment couch the radiographers will use the marks placed on your skin at CT to locate you in the correct treatment position, it is particularly important you stay very still once in position. The radiographers will then leave the room to start the treatment but may come into the room at different times if required. You will be closely monitored by CCTV cameras at all times to ensure you are safe, keeping still and not experiencing any distress.

Your first treatment appointment may take slightly longer than others to allow for extra checks and images to be carried out by the radiographers and to give you time to adjust to your surroundings. Everybody's treatments can be different lengths of time so please do not worry if you notice yours is different to somebody else's.

If you would like to listen to some music while you are in the room, please let the radiographers know. You are welcome to bring your own music, just have it ready for the radiographer to switch on.

Once your treatment is complete please remain on the treatment couch until the radiographers tell you it is safe to move. You are then free to leave the department.

Your appointment list may arrive through the post. Alternatively, you may be contacted by our radiotherapy bookings team regarding your first appointment in radiotherapy and given your full list at one of your early appointments. An example of the appointment list you may receive is below:

Types of appointment ('Activity')

• Mould Room: If you are having radiotherapy to your head and neck region or a limb you may need to have a treatment mould made. The mould room technicians will talk you through this process and will then make your mould which will be used for all subsequent radiotherapy appointments.

• CT Scan: Therapeutic radiographers will scan the area of your body to be treated in order to allow your consultant to plan your treatment specific to you.

• Blood test: You may need one or more blood tests whilst undergoing radiotherapy treatment. If these are on your appointment list, they will take place within the radiotherapy department unless you are told otherwise.

• Chemotherapy: If you are having chemotherapy, this will take place on Level 5 of BHOC unless you are told otherwise.

• Pre-treatment chat: A conversation with a therapeutic radiographer to discuss what will happen during your treatment and any side effects you might experience. This is also a great time to ask any questions you may have before starting your treatment.

• 1st Radiotherapy: Your radiotherapy treatment will be given by a team of therapeutic radiographers. Your first treatment appointment is usually slightly longer than your subsequent treatments to allow a little extra time for you to become familiar with the process.

• Radiotherapy: Your subsequent treatment appointments may be slightly quicker than your first.

• Review: An appointment with a review radiographer who specialises in your treatment. They will talk to you about any concerns you may have and can offer support.

• PICC Placement/Line Care: Appointments with the PICC team to insert your PICC line and subsequent appointments to maintain the PICC line-these appointments are usually on level 5 of BHOC unless you are told otherwise.

If you have any further questions about your appointment list, please do speak to any member of the radiotherapy team and they will be happy to help.