Note: This post was originally the last half of the preceding one (dated 10/9) but I realized that the Hump Day post was entirely too long, and also wanted to be able to refer to it separately in reference to just the radiation portion of my therapy.
I’m learning more about radiation therapy, and settling into a routine for the treatments. As I wait for my name to come up on the annunciator, I get out my fluoride trays and write down the songs I want them to play that day during the treatment. The burns are now quite painful, and very visible. I have a red zone all the way around my neck, and in a ring around my Trapezius and upper chest, down past where my shirt collar is. They have told me to use absolutely nothing but 100% Aloe Vera gel on it, but that only makes it hurt worse.
…so in I go, and find my therapists at the workstation in the hallway outside the treatment room. I must tell them my name and birth date, every day, to be sure it’s really me. Would not want to nuke the wrong guy in the wrong place… and they have my program up on the computer screens, and a pair of little video monitors to keep an eye on me while the rays are frying me.
Once inside the treatment room, I put my stuff on a shelf next to the sink, rinse my fluoride trays and put them in my mouth, and head for the Linac.
The therapist reminds me to leave my glasses behind (I forget almost every time) so I return and place them next to my bags, then get on the table. The therapist (or sometimes a pair of them) pull and push my body around on the gantry table, to line it up with a set of three lasers that locate it precisely, using a 2mm dot which was tattooed onto my chest at the first treatment. They place the mask over my face, and I have to make sure I am keeping my chin up and not fighting the mask, so my head will be exactly right. There is a wedge under my neck, to keep me firmly anchored in the mask. Lately, they have to shim that up because of my weight loss making my face thinner and not tight in the mask. Lying there on my back, I see the back-lit ceiling mural, and then the mask obstructs it, and I can only see things vaguely through the grid… oh, well, no glasses, any way.
Sometimes, the Linac’s head sits directly above me as the therapists are leaving the room, and I can see the pattern of the opening the X-rays come through, shaped as it will be for the start of the first dose.
The Linac I am usually under In is a Varian Clinac. Here’s a video of how it works:
SmartArc programmed control varies the shape of the aperture as it rotates the head around the patient, shaping the beam to the target at every angle. That’s more accurate than the five-shot system described in the video. Sometimes I go to the Trilogy system nearby. It’s more accurate still, and quieter than the Clinac, but the ♪♫ music ♫♪♫ is not as good.
Once in a while, I can even see the leaves of the collimator (not the ones in the mural) sliding back and forth as the head passes over me. There are two passes, 360° each, in opposite directions, which have different collimator patterns to get different parts of the cancer. Each pass takes a couple of minutes, but all the setup and adjusting and safety protocols add a lot to that, making it take 15~30 minutes from arriving at the Linac, to leaving. More on the linac in another chapter, some directly from the Medical Physicist in charge of the death rays that are saving my life: