During consultation, your radiation oncologist will explain the need for radiation therapy and the potential side effects
Step 1 - Consultation
When you are first referred for a radiation oncology review, you will be seen by a radiation oncologist who will discuss with you the need for radiation therapy for your condition, and the potential side effects you may encounter. Sometimes, further tests may be required before a decision to embark on radiation therapy can be made.
Do not hesitate to ask your oncologist if you have queries about how the treatments are administered, the duration of the treatments, potential side effects and how these will be minimised and managed, as well as alternatives to radiation therapy treatments.
If a decision to administer radiation therapy is reached, you will be given financial counselling on treatment charges, subsidies and the quantum of eligible Medisave and Medishield deductions.
Before you leave, you will also be given appointment dates for CT simulation as well as the commencement date of your radiation therapy.
CT simulation staff guiding patient on optimal positioning
Step 2 - CT Simulation
During CT Simulation, a CT scan will be done on the area that requires treatment. This scan is done in the treatment position, and may require the use of immobilization devices. In addition, small permanent reference marks may be placed on the body. The immobilization devices and reference marks enable us to reproduce the position accurately during treatment, which is crucial for successful treatment. As far as possible, your therapists will ensure that the scan and treatment position is comfortable for you. Do let them know if you face any discomfort or are unable to maintain the required position.
For certain treatments, you may be required to have a full bladder or empty stomach. If contrast is needed for the scan, an intravenous plug will be placed for administration of contrast. Please inform us if you have any kidney problems, asthma or previous allergies to contrast.
Typically, a CT Simulation will require between 30 to 60 minutes. It may take slightly longer if the treatment is expected to be complex, requiring specialised equipment or preparatory work beforehand.
Radiation oncologist and therapist reviewing the plan before final approval
Step 3 - Planning
After the CT Simulation is done, the images are exported to a treatment planning system (TPS) software. Thereafter, the radiation oncologist will identify the tumour and the areas at risk that require radiation therapy, as well as the critical organs that should be avoided.
Next, our radiation therapists with specialised skills in planning will work closely with the radiation oncologists to design a radiation therapy plan that best delivers radiation to the tumour while minimising the dose to normal tissues and organs. This process is important in achieving the best possible outcome for our patients and requires adequate time. Often, a few rounds of optimisation are required before the best plan is selected.
After the plan is finalised, it undergoes several layers of checks to ensure optimal treatment, safety and accuracy of the delivered plan.
A significant portion of daily treatment time is spent to place the patient in the exact treatment position required
Step 4 - Treatment and Review
When the radiation therapy sessions commence, you will be required to attend treatment daily. A radiation therapy schedule will be provided to you to inform you of your treatment times.
During treatment, radiation therapists will position you exactly as you were during the CT Simulation. You will undergo radiation therapy in a treatment room with radiation therapists monitoring your progress via a CCTV during the process.
Some days, treatments may seem to last longer due to additional imaging being done to ensure accuracy of the treatment. During the course of treatment, you will be scheduled for weekly appointments to see your radiation oncologist where you will be monitored for any side effects developed during the treatment process, as well as tumour response, if applicable. You may also be given medication to relieve some of the side effects.
In addition, weekly consultations with our in-house dietitian may be arranged for patients whose nutritional status warrant review.
A follow-up session will be conducted to monitor any potential side effects as well as track tumour response to treatment
Step 5 - Follow-Up
Upon completing the course of radiation therapy, you will be given a follow-up appointment. The purpose of a follow-up session is to monitor the side effects as well as tumour response. This may sometimes involve additional imaging like diagnostic CT scans, MRI scans or blood tests.
For more information about the radiation therapy treatment process, please click here.