Following on from my most recent posting, where a need for radiotherapy is indicated, preliminary visits to the department will be arranged; this is in order to plan the detail of whatever treatment is being prescribed: i.e. where the x-ray is required to enter the body. Further planning is thereafter commonly carried out on a machine known as a “Simulator”, which takes x-ray pictures to ensure absolute accuracy in treatment delivery.

Visits to other departments at this time for a C/T (or CAT scan i.e. computer assisted tomography·) may also be required and planned accordingly. Marks will most probably be made on the skin with a special pen to indicate the precise position where light beams are required.  In some cases a perspex shell may be made up to fit the contour of any given part of the body to ensure that x-ray beams will touch only the affected area(s).

Where radiotherapy is to be given to the head, a perspex (see-through) mask is commonly made up to fit to ensure accurate positioning and to keep the head completely still. Any marks required may then be made directly onto the mould itself, rather than on the skin. You may be certain that openings will always be incorporated to ensure that the eyes, nose and mouth are not covered.  Great care is exercised throughout to ensure that x-ray beams will be similarly and precisely positioned at each visit.

As we have seen again and again throughout these letters, the nature of interpretation (i.e. how we perceive happenings and events) is everything. My involvement with patients experiencing difficulties with a mask or face shield has unerringly led me to conclude that in the vast majority of cases where difficulty is experienced, the mask per se is not the problem. After all, most of us have comfortably and enthusiastically encountered masks in childhood, perhaps in a school play or at Halloween, or on Guy Fawke’s night. Similarly, many adults have, from time to time, used them in leisure-time activities as ‘a bit of fun’ at a Masked Ball or whatever.

What is much more likely to occasion a problem within the context of treatment of this kind is that the mask may very well have now assumed unpleasant and even sinister connotations associated with our present feelings of apprehension and fear. When we come to review the range of relaxation techniques and strategies readily available, we shall also see how, employed on their own or with a surrogate· mask (which can quickly and easily be made up or adapted to the purpose), things can swiftly change for the better. In the vast majority of cases, patients quickly adapt to the need for use of facial or other body protection. However, where (as occasionally may be the case) problems of this kind hang around, appropriate help is always likely to be at hand. (we shall consider specific aspects of all of this in greater detail in due course).

Sometimes diagnostic procedures are deployed which may, to a lay perception, appear similar to those techniques described above but which do not in fact employ x-rays at all. One such ‘state of the art’ approach is known as magnetic resonance imaging (MRI). This requires that the patient lie fairly motionless in a tube-like structure for around 20 minutes. Anyone who has actually experienced MRI – especially if they are somewhat claustrophobic – will immediately recognize the need for a few moments in which to compose one’s self before entering the actual scanner. (a simple, appropriate relaxational diversion of some nature can prove extremely useful and worthwhile). Should the need for MRI be indicated in your case, you might also find it somewhat noisy, although headphones and light music/relaxing narrative will markedly reduce any irritation that this might occasion.

Another ‘state of the art’ diagnostic procedure is one which is now commonly used during pregnancy in order to monitor the progress of the foetus – namely “Ultrasound”. It functions by interpreting into images the echoes of sound waves being sent back from the body. This method has proved to be especially useful in identifying tumours in the abdomen and pelvis.

It is common practice for a patient to be assigned to a particular consultant oncologist·. However, it is unlikely that patients attending one of these ‘state of the art’ centres will invariably be seen by the same doctor. Some people find this off-putting, preferring the opportunity to, as they regard it, “build up a relationship” with “their doctor”. However, there truly are very many advantages where several members of medical and nursing staff become involved in this way and I should like to very briefly consider some of them in my very next blog.

  • · The technique of using X-rays or ultrasound waves to produce an image of structures at given depths

within the body.

  • · A “stand in”; a substitute.
  • · (Most consultant oncologists are likely to be engaged in on-going collaborative research with other

   colleagues from their own and other Centres


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