The radiotherapy team plans your external beam radiotherapy before you start treatment. This means working out how much radiation you need and exactly where you need it. Your planning appointment takes from 15 minutes to 2 hours.
You have a planning CT scan in the radiotherapy department.
Your radiographers tell you what is going to happen. They help you into position on the scan couch. You might have a type of firm cushion called a vacbag to help you keep still.
The CT scanner couch is the same type of bed that you lie on for your treatment sessions. You need to lie very still. Tell your radiographers if you aren't comfortable.
Injection of dye
You might need an injection of contrast into a vein in your hand. This is a dye that helps body tissues show up more clearly on the scan.
Before you have the contrast, your radiographer asks you about any medical conditions or allergies. Some people are allergic to the contrast.
Having the scan
Once you are in position your radiographers put some markers on your skin. They move the couch up and through the scanner. They then leave the room and the scan starts.
The scan takes about 5 minutes. You won't feel anything. Your radiographers can see and hear you from the CT control area where they operate the scanner.
Radiotherapy treatment mask (shell)
Some people have radiotherapy to treat leukaemia cells that have spread to the brain or spinal cord. It is not common for leukaemia to spread in this way. If you are going to have radiotherapy to the brain, your radiographers might make a mask for you called a thermoplastic shell.
Your radiographer or technician makes your mask in the radiotherapy department. They might call the mask a radiotherapy shell.
The mask covers your face, and the top and sides of your head. It attaches to the couch when you are lying down for the planning scan or radiotherapy treatment.
The process of making the mask can vary slightly between hospitals. It usually takes around 30 minutes.
Before making the mask
You need to wear clothes that you can easily take off from your neck and chest. You also need to take off any jewellery from that area.
Facial hair, long hair or dreadlocks can make it difficult to mould the mask. Your radiotherapy team will tell you if you need to shave or tie your hair back.
Making the mask
The technician uses a special kind of plastic that they heat in warm water. This makes it soft and pliable. They put the plastic on to your face so that it moulds exactly. It feels a little like a warm flannel and is a mesh with holes in so you can breathe.
After a few minutes the mesh gets hard. The technician takes the mask off and it cools down. You might need to have one more fitting to make sure it is exactly right.
You wear the mask for your planning CT scan. Your radiotherapy team keep the mask in the department for when you go back for treatment. You wear it for each treatment session.
Voiceover: Making a mesh mask for radiotherapy takes a few minutes.
Radiographer: I am just going to heat this up now if you just keep nice and still there and just want to close your eyes for us.
Voiceover: The radiographer softens the mask by putting it in warm water for a minute or two. When the radiographer puts the mask on to your face it will feel warm and damp. They then clip it to the bed that you are lying on. It takes a minute or two to dry into the shape of your face. The radiographers will mark the mask where the light lines are.
Radiographer: Okay, you are just going to feel us pressing down on the mask there; you are doing really well are you still okay?
Voiceover: They use the marks on the mask to line up the machine each time you have treatment. The mask keeps you head still and makes sure that your treatment is directed at the cancer. They put your name on the mask and keep it in the radiotherapy department ready for your treatment.
Patient: They um told me about the procedure, a mask being fitted, uumm that it would be moulded to the shape of my face. Umm which they did, three lovely girls umm put my mind at ease, sat me down, heated the mask, moulded it around my face, um not an uncomfortable thing at all to go through.
You may need a mask made for any radiotherapy treatment to the brain or the top of your spinal cord.
Radiotherapy planning for TBI
You might have radiotherapy as part of a stem cell transplant. In this case you have radiotherapy to your whole body. This is called total body irradiation (TBI).
First you have a planning session of about an hour to create the treatment plan. You usually lie on your back on the couch. You might have your arms across your chest or resting on your lower tummy (abdomen). Your radiographers will put support pads (cushions) under your knees and you might also have supportive pads around your body to keep you in position.
Your radiographers take several measurements and then you have a CT scan. They will make two very small permanent dots on both sides of your hips. They use these marks to help put you in the correct position when you have your treatment.
During this session you might have a very small dose of radiotherapy. This is to help with the planning. You have no side effects from this.
After your planning session
Your radiographers will tell you when to go back for your treatment sessions. It takes at least a few days for your radiographers and doctors to create your radiotherapy plan.