Patient and Support Services
In the Spotlight
Jody Wipperfurth is a radiation therapist with the UW Carbone Cancer Center. Meet Jody in words and pictures and learn what she does.
What happens when a patient undergoes radiation therapy? University of Wisconsin Carbone Cancer Center radiation oncologists have created this guide to radiation treatment.
- Meeting with a Radiation Oncologist for a Consult
- Treatment Planning CT Scans and Simulations
- Treatment Planning
Meeting with a Radiation Oncologist for a Consult
Before deciding if you would like to receive radiation therapy treatments, you must first meet with a radiation oncologist to help decide if radiation therapy is right for you.
During your consult, you will first meet with a nurse. The nurse will take you into an exam room to record your weight, vital signs, medications, and allergies.
Next you will meet with the doctors - typically a radiation oncology resident and radiation oncologist will meet with you. They will examine you and ask you questions. You may be asked about your current medical problems, past medical history, past surgical history, medications, and lifestyle.
Treatment options, as well as the benefits and risks of these options, will be discussed with you. If radiation therapy treatments are indicated, the doctors will talk to you about treatment plans. If you decide that radiation therapy is right for you, you will be scheduled for a planning CT scans and/or simulation.
Other staff members you may meet during your consult visit are: medical students, radiation therapy students, nurse practitioners, physician assistants, and research associates.
Treatment Planning CT Scans and Simulations
In order for the radiation beams to be effective, they must be aimed at the same target for each treatment. The process of measuring your body and marking your skin to help your team direct the beams is called a simulation or treatment planning CT scan.
During a simulation or treatment planning CT scan, you will be positioned on the table the same way you will be for treatment. Because positioning is so important for your treatment, you may have a special mask or mold made. The radiation therapists will mark the area on your body that the doctor wants to be treated with radiation therapy and take X-ray images of the area. Depending on the area treated, your physician may request that you receive IV contrast or barium to drink.
Contrast is used to highlight organs so that they can be seen on X-ray or CT images. After your X-rays or CT scans are completed the radiation therapist will mark your skin with a set a small, permanent tattoos. The tattoos will be used to position you each day for your radiation treatments.
Once you have finished with your treatment planning CT or simulation, your radiation oncologist and other members of the treatment team review the information. This step takes place even though you are not in the radiation oncology department. Tumors are not regular - they come in different shapes and sizes. To design the radiation therapy to the size, shape and location of your tumor, your treatment team (radiation oncologists, residents, medical physicists and dosimetrists) uses computers and your treatment planning images to plan your treatment.
Depending on the complexity of your treatment, this step can take anywhere from two days to two weeks. After reviewing all of your information and your treatment plan, your doctor will write a prescription that outlines exactly how much radiation you will receive and what parts of your body will receive the radiation.
The radiation therapist will give your treatment following your radiation oncologist’s instructions. The first day of treatment will take approximately 45 minutes. After the first day, your treatments will take approximately 15-30 minutes. The radiation therapists will help you lie down on the table in the same position you were in for the treatment planning CT or simulation. They will be using the tattoos that were placed on your skin during your treatment planning appointment to help position you and may make shifts according to your treatment plan.
Once you are positioned, the radiation therapist will take X-rays (also called port films). Port films are taken on the first day of treatment and once a week. The port films are used to check your positioning and do not show if any disease is present. After your doctor reviews the port films, you will receive the first treatment. During the port films and your treatments, the therapists will step out of the room. They are closely monitoring you on a television screen while giving your radiation.
There is a microphone in the treatment room so you can always talk with the therapist if you have any concerns. The machine can be stopped at any time if you are feeling sick or uncomfortable. During your treatment, the therapist may move the treatment machine or treatment table. The machine might make noises during treatment that sound like clicking, knocking or whirring but the radiation therapist is in complete control of the machine at all times.
Weekly Status Checks
During radiation therapy, your radiation oncologist and nurse will see you regularly to follow your progress, evaluate any side effects, and address any concerns you may have. You may want to bring a family member or friend with you to these appointments.
After Treatment: Follow-Up
After treatment is completed, follow-up appointments will be scheduled so that your radiation oncologist can make sure your recovery is proceeding normally and can continue to monitor your health. Your doctor may order labs, X-rays and other diagnostic tests.
As time goes by, the number of times you need to visit your radiation oncologist will decrease. However, please know that your radiation oncology team will always be available if you need to speak to someone about your treatment.
Glossary of Radiation Oncology Terms
Applicator: A device used to hold a radioactive source in place during brachytherapy.
Beam Films: Another term for port films, beam films are pictures of the position of the radiation beams used to treat cancer. They are used to verify the position of the beams and confirm that treatment is delivered to the right place.
Blocks: Pieces of metal alloy that can be used to shape the radiation beam. Also called cerrobend.
Boost: An additional dose of radiation that is given after an initial course of radiation to enhance tumor control.
Brachytherapy or Implant: Internal radiation therapy that involves placing radioactive sources inside or next to a tumor.
Cancer: A group of diseases in which abnormal cells divide uncontrollably, forming a tumor or mass.
Clinical Trials: Studies that test new cancer therapies.
Image-guided Radiation Therapy or IGRT: A radiation treatment guided by imaging equipment, such as CT, ultrasound, or x-rays, taken in the treatment room just before radiation is given.
Immobilization Device: A device that is used to help a patient remain in the same position during every treatment.
Intensity-modulated Radiation Therapy or IMRT: IMRT is a specialized form of external beam therapy that can help improve how the radiation is shaped to fit your tumor.
Linear Accelerator or Linac: The most common type of machine used to deliver external radiation therapy.
Metastases: Cancer that has spread from one part of the body to another, such as from the breast to the lymph nodes or bones.
Multileaf Collimator or MLC: A part of a linear accelerator that is used to shape the radiation beam.
Palliative Care or Palliation: Treatment that is intended to relieve symptoms, but not cure disease.
Radiation Oncologist: A doctor who specializes in treatment cancer and other diseases with radiation therapy.
Radiation Therapy or Radiotherapy: The use of radiation to treat cancer and other diseases.
Simulation: The process of planning radiation therapy to allow the radiation to be delivered to the intended location.
Tomotherapy: A type of machine has the ability to image a patient and deliver radiation therapy treatments.
Treatment Plan: A radiation oncologist’s prescription describing how a patient should be treated with radiation therapy. The radiation oncology team uses special software to maximize radiation to the tumor while sparing healthy tissue.
Questions for Your Radiation Oncologist
- Questions to Ask Before Treatment
- Questions to Ask During Treatment
- Questions to Ask After Treatment
Questions to Ask Before Treatment
- What type and stage of cancer do I have?
- What is the purpose of radiation treatment for my type of cancer?
- How will the radiation therapy be given? What do the treatments feel like?
- How many weeks will I receive radiation? How many treatments will I receive per week? How long does each treatment take?
- What are the chances that radiation therapy will work?
- What is a clinical trial? Can I participate in a clinical trial? Do I have to be on a clinical trial?
- What is the chance that the cancer will spread or come back if I do not have radiation therapy?
- Will I need chemotherapy, surgery or other treatments? If so, in what order will I receive these treatments?
- What are some of the support groups I can turn to during treatment?
- If I have questions after I leave here who can I call?
- Will radiation therapy affect my ability to have children?
- Do you take my insurance?
- Can I get a second opinion?
- Do all patients have similar side effects?
- How often will I see my radiation oncologist while I am receiving radiation therapy?
Questions to Ask During Treatment
- How can I expect to feel during treatment and in the weeks following radiation therapy?
- Can I drive myself to and from the treatment facility? Is their transportation assistance available?
- Will I be able to continue my normal activities?
- What side effects may occur from the radiation and how are they managed?
- Do I need a special diet during or after my treatment?
- Can I exercise?
- Can I have sex?
- Can I smoke or drink alcohol?
- Can I go out in the sun?
- What types of lotions or soaps can I use?
- Is it safe to take vitamins during treatment?
- Who can I contact if I have problems after clinic hours?
Questions to Ask After Treatment
- How and when will you know if I am cured of cancer?
- What are the chances that the cancer will come back?
- How soon can I go back to my regular activities?
- How often do I need to return for checkups?
Your Radiation Oncology Team
- Radiation Oncologists
- Radiation Oncology Residents
- Radiation Oncology Nurses and Physician Assistants
- Radiation Therapists
- Medical Radiation Physicists
- Nutritionists and Speech and Swallow Therapists
- Physical Therapists
Radiation oncologists are the doctors who will oversee your radiation therapy treatments. These physicians work with the other members of the radiation therapy team to develop your treatment plan and ensure that each treatment is given accurately. Your radiation oncologist will also monitor your progress. Before, during and after your radiation therapy treatments, your radiation oncologist works closely with other cancer doctors, such as medical oncologists and surgeons, to make sure you are receiving the best treatments for your cancer.
Radiation oncologists have completed at least four years of college, four years of medical school, one year of general medical training and four years of residency or specialty training in radiation oncology. They have extensive training in cancer medicine and the safe use of radiation to treat disease.
Radiation Oncology Residents
Resident physicians are fully licensed physicians, working under the supervision of the attending physician. Radiation oncology residents are completing advanced specialty training. They are highly skilled in hospital medicine and provide direct supervision for less experienced junior residents who are beginning specialized training. Resident physicians work closely with your attending physician in planning and providing your care.
Radiation Oncology Nurses and Physician Assistants
These professionals work together with radiation oncologists and radiation therapists to care for you and your family during your radiation treatments. They will explain the possible side effects you may experience and describe how you can manage them. They will assess how you are doing throughout treatment and will help you cope with the changes you may experience. They will also provide support and counseling to you and your family.
Radiation therapists work with radiation oncologists to administer the daily radiation treatment under the doctor’s prescription and supervision. They maintain daily records and regularly check the treatment machines to make sure they are working properly.
Radiation therapists go through a two-four year educational program following high school or college. They take a special examination to be certified by the American Registry of Radiologic Technologists.
Dosimetrists carefully calculate the dose of radiation to make sure the tumor gets enough radiation. Using computers, they work to develop a number of treatment plans, working with the radiation oncologist and the medical physicist.
Many dosimetrists start as radiation therapists. After extensive training or special schooling, they become dosimetrists. Dosimetrists are certified by the Medical Dosimetrist Certification Board.
Medical Radiation Physicists
UW Health medical physicists work directly with radiation oncologists during treatment planning and delivery at the University of Wisconsin Carbone Comprehensive Cancer Center.
They oversee the work of the dosimetrists and help ensure that treatments are tailored to each patient. Medical physicists are responsible for developing and directing quality control programs for equipment and procedures.
Our experienced team of experts is involved in the treatment of every patient, and incorporates recommendations and guidelines from the American Association of Medical Physicists (AAPM), American College of Radiology (ACR) and the American Society of Therapeutic Radiation Oncology (ASTRO) in addition to federal and state guidelines.
The medical physics group determines the need for and establishes specifications for dosimetric and treatment planning equipment, including:
- Measurement instruments to calibrate all treatment equipment and patient monitoring devices, including ionization chambers/electrometers used as local standards and field instruments, readout devices, constancy check instruments and phantoms
- Computerized treatment planning systems
- Computerized water phantom systems with appropriate ionization chambers or diodes
- Film density systems
- Patient dose monitoring systems, such as diodes and thermoluminescence dosimeters (TLDs)
- Radiation protection measurement devices
- Quality assurance test tools for radiation therapy equipment
Nutritionists and Speech and Swallow Therapists
These health professionals will work with you to help maintain your diet during radiation therapy treatments. They will help you modify your eating plan if the side effects of treatment are affecting your appetite, will determine what you can eat, and can provide recipes, menu suggestions, and eating tips. They address dietary issues and current developments that may affect cancer treatment outcomes.
Physical therapists use therapeutic exercises to ensure that your body functions properly while you are undergoing treatment. These exercises are used to help manage side effects, alleviate pain, and keep you healthy.
Dentists may be involved in the care of patients who are receiving radiation for oral or head and neck cancers. They will help prevent the radiation from damaging the healthy areas of your mouth and oral cavity, and may recommend that you have preventive dental work done before your radiation treatments. They may help you manage some of the side effects from your radiation treatments.