Planning your treatment
Preparing for your planning appointment
The therapeutic radiographers use a planning CT scanner to collect detailed pictures of the treatment area. This information is used to ensure that we target the precise area for treatment. Although it may seem similar, this scan is not the same as any previous CT scans you may have had for diagnosing your conditions. The planning scan can be used in conjunction with previous diagnostic scans to help us to precisely plan your radiotherapy treatment. You will not normally get any results from this planning scan.
For some procedures, we will ask you to follow specific instructions prior to your first visit. You will be informed about any preparation in the first letter from us, or over the phone. Please ensure you follow any instructions given to avoid unnecessary delays.
How long does the planning take?
Please allow 2-3 hours for your planning appointment. If you plan to drive to the planning appointment, we recommend that you do not park on the side roads as these are only limited to 2 hours free parking.
The planning appointment
On arrival you will meet a therapeutic radiographer, apprentice or CT support worker who will explain the procedure and answer any questions. They will also reconfirm that you consent to the procedure.
Radiation can cause damage to an unborn baby. Therefore, if you are 55 years old or under, we must ask you to confirm that there is no possibility of pregnancy.
During the planning appointment the body part to be treated will need to be clear of jewellery and clothing. We will ask you to change into a hospital gown. We use surface guided technology so we will need to partially uncover you for the duration of your scan. But we will cover you as soon as we can.
We will need to position you in a specific way that can be reproduced for each future radiotherapy treatment. You will need to keep still for up to 20 minutes for your planning scan and for subsequent radiotherapy treatments so please let us know if we need to make you more comfortable.
Some patients may require an injection of contrast dye during the planning scan. If this is required for your scan, the radiographers will discuss this with you and insert a small tube (cannula) into the arm or hand prior to the scan. The cannula will be removed 20 minutes after the injection. We will ask you to drink some water before you leave.
Please be aware that we cannot use a power PICC or any type of central line to deliver contrast dye in this radiotherapy department.
See below for information on what you can expect depending on the specific area being treated.
Dental advice
If you are having radiotherapy which includes the mouth area you will have a dental check up before planning to assess your teeth. Some patients will need dental work completed before having radiotherapy planning and treatment. You will be informed by the head and neck team if this applies to you prior to receiving your radiotherapy planning appointment.
You will get a prescription for a special toothpaste and mouth wash which can be continued by your GP.
Keeping still for radiotherapy
When delivering radiotherapy to the head and neck it is important that the head is kept as still as possible for the duration of the treatment. To achieve this, we may need to make a mask (shell) to wear during your treatment.
A mask is made by heating a piece of flat plastic in a waterbath for a couple of minutes until it is warm and flexible. It is then stretched over the head and neck area and smoothed around your features. It takes a few minutes to dry and harden. The mask feels a bit wet and warm when it is made but you will be able to breathe normally through holes in the material.
Your mask must fit your face perfectly. If you have long facial hair, you can help us to make a well-fitting mask by trimming very short or by shaving off before your planning appointment.
You will wear the mask again for up to 20 minutes during each treatment.
Will I have an injection during the scan?
Most patients having planning for radiotherapy to the brain, head or neck regions will require an injection of contrast dye to be given during the scan.
If this is required, the radiographers will explain the process when you arrive.
The CT Planning Scan
You will need to lie on a special inclined board with arms raised above your head. It is important to continue with any arm exercises as recommended after surgery. This will help you increase your arm mobility and reduce muscle tension when we position you. If you're uncomfortable, let the radiographers know as soon as possible —they can adjust your position.
We will need to uncover your chest completely for this procedure as we use skin surface guided technology to ensure you are positioned correctly.
The planning scan itself will take around 15-20 mins.
Will I need to hold my breath?
We will ask you to try holding your breath for your scan if you are having radiotherapy treatment to the following areas:
- Left Breast
- Left Chest Wall
- Treatment to the internal mammary chain (IMC)
The radiographers will coach you to hold your breath for up to 20 seconds during your scan. If you are able to do this consistently for the planning appointment, you will be asked to do the same thing during the delivery of the radiotherapy treatment.
You can find videos and resources on the RESPIRE website which will help you to prepare.
Some patients are not suitable for a breath-hold technique (DIBH). If this is the case, we will discuss this with you at the scan.
Will I have an injection during the scan?
You will not have an injection during this scan.
Preparing for the planning scan
We will send you an appointment letter, or phone you at least 5 days in advance of the CT planning appointment with the required information if you need to prepare for the scan.
I have been told I need a full bladder and empty bowel for the scan. What can I do to prepare?
At least 5 days before your scan
- Drink plenty of fluids, ideally two litres a day (unless on fluid restriction). Water or squash is best.
- Try to avoid eating foods/ drinks which are known to make you gassy (eg baked beans, cabbage, spinach, fizzy drinks).
- Eat regular meals
- Drink and chew slowly
On the day of the scan
- Continue with good hydration. Drinking water regularly until your appointment.
- Eat a good breakfast/ lunch/ dinner (but continue to avoid gassy foods).
- Try to empty your bowels (have a poo) naturally before you leave for the department. Do NOT strain or force.
Prostate Cancer Specific Information
If you are having radiotherapy to the prostate area you can find additional information about how to prepare and what to expect here.
I have a problem with the preparation
If you have any problems with the preparation instructions given to you, or are not sure about what to do, please contact the bookings team for advice.
Will I have an injection during the scan?
Most patients having planning for radiotherapy to the pelvis will require an injection of contrast dye to be given during the scan.
If this is required, the radiographers will explain the process when you arrive.
Keeping you still during treatment is extremely important for accuracy of radiotherapy. How we position you and stop you from moving during treatment (immobilisation) will vary depending on where the cancer was found in your chest.
For cancers that are in the mid or lower chest
You will need to lie on a special board with arms raised above your head. If you have been given any arm or shoulder exercises then please continue with these. They will help you increase your arm mobility and reduce muscle tension when we position you. If you’re uncomfortable, let the radiographers know as soon as possible —they can adjust your position.
We will need to uncover your chest completely for this procedure as we use skin surface guided technology to ensure you are positioned correctly.
The planning scan itself will take around 15-20 mins but you may be in the room with us for longer.
For cancers that are in the upper part of the chest
We may need to make a mask (shell) to wear during your treatment.
A mask is made by heating a piece of flat plastic in a waterbath for a couple of minutes until it is warm and flexible. It is then stretched over the head, neck and upper chest area and smoothed around your features. It takes a few minutes to dry and harden. The mask feels a bit wet and warm when it is made but you will be able to breathe normally through holes in the material.
Your mask must fit perfectly. If you have long facial hair, you can help us to make a well-fitting mask by trimming very short or by shaving off before your planning appointment.
You will wear the mask again for up to 20 minutes during each treatment.
Will I need to hold my breath?
In most cases, we will not ask you to hold your breath for your planning scan, or radiotherapy treatment unless the consultant oncologist requests this technique.
If the breath hold technique is required, we will send you a preparation letter or phone you with more details. On the day of the planning scan the radiographers will coach you to hold your breath for up to 20 seconds during your scan. If you are able to do this consistently for the planning appointment, you will be asked to do the same thing during the delivery of the radiotherapy treatment each day.
You can find videos and resources on the RESPIRE website which will help you to prepare for a breath hold technique.
Some patients are not suitable for a breath-hold technique (DIBH). If this is the case, we will discuss this with you at the scan.
Can I eat and drink normally?
If you have a cancer of the lower oesophagus we may require you to “fast” (take no food or fluids) for 2 hours before your planning appointment. If this applies to you, we will contact you via letter or phone prior to your appointment to give further instructions.
Will I have an injection during the scan?
Most patients having planning for radiotherapy to the lung/ Oesophagus (Thorax) will require an injection of contrast dye to be given during the scan.
If this is required, the radiographers will explain the process when you arrive.
Keeping you still during treatment is extremely important for accuracy of radiotherapy.
You will need to lie on a special board with arms raised above your head. If you have been given any arm or shoulder exercises, please continue with these. They will help increase your arm mobility and reduce muscle tension when we position you. If you’re uncomfortable, let the radiographers know as soon as possible —they can adjust your position.
We will need to uncover your chest and abdomen and pelvis almost completely for this procedure as we use skin surface guided technology to ensure you are positioned correctly. We will cover your modesty.
The planning scan itself will take around 15-20 mins but you may be in the room with us for longer.
Will I need to hold my breath?
In most cases, we will not ask you to hold your breath for your planning scan or radiotherapy treatment, unless the consultant oncologist requests this technique.
If the breath hold technique is required, we will send you a preparation letter or phone you with more details. On the day of the planning scan the radiographers will coach you to hold your breath for up to 20 seconds during your scan. If you are able to do this consistently for the planning appointment, you will be asked to do the same thing during the delivery of the radiotherapy treatment each day.
You can find videos and resources on the RESPIRE website which will help you to prepare for a breath hold technique.
Some patients are not suitable for a breath-hold technique (DIBH). If this is the case, we will discuss this with you at the scan.
Can I eat and drink normally?
We may require you to “fast” (take no food or fluids) for 2 hours before your planning appointment. If this applies to you, we will contact you via letter or phone prior to your appointment to give further instructions.
Will I have an injection during the scan?
Most patients having planning for radiotherapy to the abdomen will require an injection of contrast dye to be given during the scan.
If this is required, the radiographers will explain the process when you arrive.
If you are having radiotherapy to a superficial area of your skin, a radiotherapy planning scan will not normally be required. This is called a Clinical Mark Up session.
You will be lying down on a bed in a position that is comfortable for you.
The consultant will look at your notes and your skin and decide exactly what area needs treatment. They will draw temporary marks on your skin with a pen to define the treatment area.
The radiographers will take a template and photographs of the pen marks.
The radiographers will remove the pen marks before sending you home with treatment appointments and information.
The CT Planning Scan
For this type of scan we will contact you in advance to let you know if there is any preparation. When you are taken for your scan we will ask you to lay on our couch. You will need to be able to lay relatively flat however, we will be able to modify your position to make you as comfortable as is possible. We have a range of pads and mats that we can use for this purpose. If you're uncomfortable, let the radiographers know as soon as possible - they can adjust your position. You will need to be able to tolerate the position for around 20 minutes.
If you suffer with pain, please continue to take any regular pain medication before you come. If you have any top up pain medication prescribed to you such as oromorph, please bring this with you to your planning appointment.
For the scan we will need to uncover the area of the body that will need radiotherapy.
Can I eat and drink normally?
Unless we tell you otherwise, you will be able to eat and drink normally before this type of planning.
Will I need to hold my breath?
Unless we tell you otherwise, we will not normally ask you to hold your breath for this type of procedure.
Will I have an injection during the scan?
If an injection is required, the radiographers will discuss this with you on the day, before going ahead with the planning.
