During radiotherapy

People who will look after you

Healthcare professionals from different departments will look after you while you are having radiotherapy. Clinical oncologists are doctors who are trained in radiotherapy and chemotherapy. The consultant clinical oncologist will be in charge of your care. They are supported by a team of specialist registrars, therapy radiographers, nurses and administrative staff.

Therapy radiographers are trained to plan and deliver the radiotherapy. They can give support and advice on radiotherapy side effects and how to manage them. The radiographers will have day-to-day responsibility for you while you are having radiotherapy. Your treatment-support radiographer will provide support and advice on all aspects of your treatment.

Oncology nurses provide support and advice on the side effects of radiotherapy and chemotherapy, including how to manage them. Chemotherapy nurses will be involved in delivering chemotherapy treatment if needed.

The acute oncology service (AOS) will provide emergency medical care for any urgent problems relating to the cancer or its treatment. Please phone 020 7188 3754 at any time (night or day) for advice.

Radiotherapy planning

After your first outpatient appointment with the doctor, you will be sent a letter asking you to come to the radiotherapy department at the Cancer Centre at Guy’s Hospital, or Guy’s Cancer at Queen Mary’s Hospital. This appointment is for you to have a CT scan. Please bring your appointment letter with you.

A member of the pre-treatment radiotherapy team will explain what will happen. During this discussion, you will be asked to confirm your name, address and date of birth. You will be asked for this information before every procedure or treatment done in the department. We will ask you to re-confirm consent to make sure you still want to have the treatment.

CT scan

A CT scan uses an X-ray machine to produce a series of detailed pictures showing the structures in your chest. This scan is only for planning your treatment. The images are sent to a planning computer and are used to make a 3D image of your breast or chest wall. The clinical oncologist will use this image to plan your radiotherapy.

You can eat and drink normally on the day of your scan and throughout your treatment appointments. With this type of scan and treatment, there is no risk to others around you.

During the CT scan

To prepare for the scan, you will need to remove all your clothes above the waist. We will give you a gown, but you will need to remove this for the scan and all treatments.

You will lie face-up on the CT table with your hands above your head. Your legs will be straight with your feet flat on a board. The radiographers will make you as comfortable as possible so that you can lie very still.

A radiographer will make some pen marks on your chest to mark the area that needs to be scanned. They will place thin pieces of wire on your surgery scars and secure these with tape. This is done so that the mark shows up on your scan. The pen marks, wire and tape will be removed after the scan.

The radiographers will record some measurements. These measurements help to position you correctly for your future treatments. The CT table will be raised to go through the scanner and the radiographers will leave the room. They will be monitoring you at all times through a window.

The radiographers will start the scan from outside the room. You will feel the bed slowly move in and out of the scanner, and hear the machine making noises. The scan should only take a few minutes. If you need help at any point, just wave your hand and the radiographers will return to the room.

You might need to wear a bra for treatment if your breasts are large, or if they need support. This will be provided by the department.

After the CT scan

When the scan is done, the radiographers will come back into the room. If you were asked to wear a bra for treatment, you might need to have some very small, permanent ink marks (tattoos) on your chest or tummy (abdomen), and on your side. The radiographer uses the tattoos to line up the radiotherapy machine for each treatment.

The radiographers will help you down from the scanning table and then you can get dressed. Before you leave the department, you will be given a list of all your radiotherapy treatment appointments. Please bring this list to your first treatment appointment.

You will be given a confirmed list of appointments on the first day of your radiotherapy treatment, about 2 weeks after your CT scan.

Your radiotherapy plan

Your radiotherapy plan is the personalised design of your radiotherapy treatment. It is personalised for you, and is based on the CT scan that you had. A team of doctors, radiographers and physicists will decide where the treatment needs to be directed, avoiding as much healthy tissue as possible.

A treatment radiographer will discuss your treatment with you, and you can ask any questions. You will be asked to change into a gown, and then be taken into the treatment room.

You will be asked to lie on the treatment table, which will be set up with the same equipment as when you had your CT scan. Radiotherapy treatment is given by a machine called a linear accelerator, often called a ‘linac’. Try to relax, stay still, and breathe normally.

The lights will be dimmed. This is so the radiographers can see the lasers that help them to position you correctly. You will hear the machine move around you. It will come close to you but will not touch you. You will hear radiographers taking measurements. You will feel the bed moving and see some red lights turning on and off. When you are in the right position, the radiographers will leave the room.

You will then hear a buzzing sound. This is the door safety interlock. You will be alone in the room during your treatment, but the radiographers will be monitoring you all the time on camera (CCTV).

If you need help at any point, just wave or raise your hand, and the radiographers can immediately return to the room.

Digital X-ray images are taken regularly during your treatment to make sure that the treatment is being delivered accurately. There will be a short delay while these images are assessed, and you might feel the bed move as the radiographers adjust its position from outside of the room. Treatment will then be delivered and the machine will move around you to treat you from different angles. This whole process will take about 20 minutes.

Afterwards, the radiographers will return to the room and help you down from the treatment table. The treatment table will be quite high up, so it is important that you do not move or try to get off the table without help. The radiographers will tell you when it is safe to sit up and get off the table.

Treatment review

You will be seen by a member of the treatment support team during your treatment and they can help you to manage your side effects. You will have separate appointments for this on your appointment list.