Ok, yesterday I didn't do a very good job of writing about my first experience on ‘The Table’ so here’s a bit of both yesterday’s and today’s (8.8.2013)
The first thing you have to realise is of course, is about being fitted with and wearing the mask or maybe a metal frame. Depending on what type of radiotherapy you're having, one therapy called 'Gamma Knife' which is often called 'radio surgery' is a high strength one shot dose aimed at the tumour concerned that is suitable for that treatment, with the intent of knocking it dead in its tracts.
Depending on this and what machine is used, a cage like helmet is fitted to the head by bolts which are secured tightly to the skin at points around the head and the 'cage' is then secured in a frame to keep the head absolutely still while the therapy is applied. Stereo tactic radiotherapy I think uses the same or similar frame as the doses are given over a short period of time. But at the Royal Marsden, with the protracted fractionated stereo-tactic radiotherapy I am having (usually 30 doses over six weeks) then a thermoplastic mask is used to secure the head.
Here's a link to the Royal Marsden pages about radiotherapy assessment with a video that takes you through the process.
The bench you lie on under the Linac machine is on a floor mount which rotates from side to side over about 180 degrees if needed, and the machine itself will rotate over the target area. The machine takes two x-rays so as to line up and target the position, with two points crossing on a map. This is to check again the head is in the right place and the target area is also worked out from the structure of the skull which also helps to accurately define the target.
The technician in the radiotherapy department was very kind to show me the movement of the bench and Linac, because obviously with my head encased in a plastic mask which also goes over my eyes, I can only feel the motion, not see what is moving.
Also she showed me the controls which are used for both the Linac and the bench to rotate them to the desired position. The Linac then fires the dose and will do so over several different angles so that all of the affected area can be targeted over the desired period of time. The bench can also be tilted up and down, and side to side, head or feet up/down although the positioning is very subtle.
The experience I had yesterday (7.8.2013), initially I had found it initially difficult to get comfortable when the mask was placed over my head, as it is hot at the moment and my skin felt sticky but today was not so bad and I was more relaxed to the point of dozing off! As they put the mask on, I was advised ot tuck my chin down a little so the mask could be secured in to place. My mask has no holes for the eyes and is very firm across the face, but there is an opening for my nostrils and mouth. The mask completely covers my head, down over the top of the head, the ears and down as far to my chin, the underside of my chin isn't covered.
It is very important from the outset if fitted with this type of mask, to let the staff know if you have problems with pain, and of course, claustrophobia or anything else as you are penned in very firmly. I don’t usually get claustrophobia, but I have had to learn to relax a bit with this. Of course if it gets too much, the staff will immediately stop everything and help you. It was stated quite firmly they do not want anyone to suffer unnecessarily.
I was helped up on to the bench and had to use a step ladder to do so (as I am a bit short!) and then laid down, with my head placed in a moulded head rest and my legs elevated a little over another moulded leg rest, to ensure the most comfortable position. After this, the mask is clipped on to the table and checked that it is firmly in place. The staff let you know that the bench is about to move and that you will hear the Linac rotate. It was a strange sensation feeling the table rotating and rhen hearing the Linac do the same.
The term 'field' comes up a lot when the technicians are sorting out the machine, and is used to decribe the areas which the Linac will target. When it was set into position, I could hear a clicking like a camera shutter going off but louder and this is the actual firing of the dose of radiation to the target. I did hear a bit of whirring as it then repositioned and maybe a sensation of shadows as it moved, but this is normal. In the background, some music was put on which I found soothing, and ironically for me being a science fiction fan, Strauss's 'Vienna Waltz' was playing as the machine moved, so I imagined I was in a Stanley Kubrick scifi movie...LOL!!
After about 20 mins, the mask was removed and it can be a little disorientating to find I was pointing in a completely different position than I started! And as said before today, the technician was very kind in showing me the range of movements the table and machine are placed. There are various monitors in the room mounted on arms so the staff can read various data etc. In the Royal Marsden sites, there are a number of machines of various types used for radiotherapy and vary because of the different range of treaments required.
A note to the wise though, if you still feel a bit disorientated afterwards, go and have a little sit down in the waiting area, there is water and you can make a hot drink if you wish until you feel ok.
Here's a link to the Royal Marsden web pages with photos of the types of machines used at the Royal Marsden sites, you can browse through the photos of the machines by clicking on the links below the images here.
Here is a photo of the Lederman machine (Varian Clinic 2100C) that I will be treated with, bar three days due to the machine being serviced.
|The Lederman machine, a Varian Clinac 2100C. Image copyright to The Royal Marsden|
Next week for three days, I will also be treated with this machine named the Joe Ford machine which I think is a similar type to the Lederman.
|The Joe Ford Machine. Image copyright to The Royal Marsden|
Here are some photos of the machines in various angles I have picked up from the web to give you a rough idea of what happens.
|Note the mask on the patient's head. It is a similar type to mine.|
|One of the many postions the machine is set so to deliver the dose at the angles required.|
Ok, that's enough for me for now. Will try to look at some of the potential side effects of radiotherapy as was explained to me in my case later. Now I'm off to bleedin' bed! Feedback would be welcome by the way.