CT Simulation for Radiotherapy planning Simplified.

What to expect in first visit?

CT Simulation is done before your radiotherapy treatment. When your doctors decide that you need Radiotherapy as part of cancer treatment, you are given an appointment for CT-Simulation. It is also called radiotherapy planning.

• What Happens In CT-Simulation
• Simulation in Breast Cancer
• Simulation in Prostate Cancer
• Simulation in Children
• Simulation in Cervix Cancer
• What happens after simulation
• First Day of Radiotherapy.

What happens in CT-Simulation?

In your CT simulation visit, CT-scan of target area is done in a special CT-scan machine called CT Simulator. Special devices for fixing you intable like plastic masks or vacuum bags are used during simulation. Sometimes your doctor will give dye injection during CT simulation.

Your therapists will assist you lie down on a desk and make each attempt to make certain your comfort and privacy. If you experience uncomfortable at any time, please inform your therapist. If you are in pain,please take pain medicine before simulation. You have to lie in certain position in hard couch. The lights and lasers will turn on and off during simulation. The table-top will also move in different direction during simulation.

Instruction for CT-simulation:

1. Please follow diet advice according to instruction. You may be asked to not eat anything or take specific amount of liquid .
2. Remove any ornaments or metal lockets etc before simulation.
3. Simulation may take 1-2 hour depending on complexity. So make sure you have adequate time for simulation.

Simulation in Breast Cancer

You have to lie down in a slanting board called breast board. There are adjustable handles to hold your hand in position. In left breast cancer, saving the heart is an important priority. We routinely use Deep Inspiration Breath Hold (DIBH) technique to save your heart during therapy. The therapist will teach you breathing exercise and breath holding techniques for DIBH.

Simulation for Prostate cancer.

In prostate cancer, saving your large intestine and urinary bladder is the main priority. Constipation should be avoided. So special bowel preparation techniques are to be followed. Your intestine needs to be empty and stool soft before simulation. Some stool softners may be needed to clean the bowel. For instructions about fluid intake, please follow the protocols provided.

Simulation for small children.

For small children who can.t follow instructions, sedation or general anesthesia may be needed. Anesthesia team will provide short anesthesia for treatment every day if needed for radiotherapy under anesthesia.

Simulation for cervix cancer.

In cervix cancer bladder filling is very important to reduce side effects. So you will be given instructions to drink specific amount of water and hold your urine before simulation. Similarly there should be no constipation before simulation.

What happens after simulation.

After CT-Simulaton, you can take dates for radiotherapy treatment and go home. If there are special markings placed in your skin, you may have to save it. Doctors may ask you for MRI or PET-Scan images in CD ROM/ Pen drive or DICOM format for more precise radiotherapy planning .

You are given date for your first Radiotherapy session. Head and neck patient may need to get dental appointment for oral checkup and dental prophylaxis.

Meanwhile, your oncologists will analyze these images in special computer software called Treatment planning system(TPS). We use [MIM software] and MONACO TPS. if you have undergone MRI or PET CT, those images are also imported to TPS and they are fused for better target mapping. Radiation oncologist will map your tumor and important organs in CT -simulation images.

Then Medical Physicist will decide how to give prescribed amount of radiation precisely and safely to the target that is the tumor.All these planning and dose calculation are done in computer and your treatment is planned. Finally the planned treatment is approved by your cancer doctor.

First day of Radiotherapy.

You can take your meal and come for first day of treatment. Please follow any special advice on taking water or fluids.

In first day of treatment, you are scheduled for Setup. In this process, patient is taken in treatment couch and all masks are fitted. Then laser matching is done. Next treatment position is verified and first dose of treatment is delivered after confirming the position is in perfect match.

First day treatment usually takes longer time due to setup and verification process.

Radiotherapy treatment is painless. And you do not become radioactive after treatment. So you can safely go back to home and meet friends and family after treatment. From second day onwards you will get an appointment time and you will get treatment and go back home. This process is repeated every day for 5 days a week.

If you need  transportation facility for coming to treatment, you can contact front-desk/reception. Our vehicle will provide pickup and drop in ring road area of Kathmandu , patan and Bhaktapur. If you are looking for place to stay during your cancer treatment, talk to our case manager. We are always ready to help you and make your stay and treatment comfortable.