Steps of Radiation Therapy Treatment
Radiation therapy treatment involves several steps:
On this page: CT Simulation
On this page: Planning
On this page: Treatment
On this page: Review
On this page: Follow-up
1. CT Simulation
CT simulations are booked Monday to Friday between 9:00 AM and 5:00 PM.
Your CT simulation appointment is the first step in designing your personalized radiation therapy treatment plan. The simulator (a special CT scanner) takes pictures of your treatment area. Your radiation team uses these pictures to design your treatments.
Your CT simulation appointment will take about 30 to 45 minutes.
When you arrive:
Check in with the Patient Flow Coordinator on level 1B of Princess Margaret Cancer Centre. The Patient Flow Coordinator will:
- Take your photo. This helps to correctly identify you at your appointments.
- Ask if you prefer a certain time of day for your appointments. We will do our best to meet your request, however it is not always possible.
- Ask you about your travel and accommodation arrangements.
During Your CT Simulation:
Radiation therapists will perform the CT simulation. They will:
- Position you on the simulator bed
- Take CT images of your treatment area
- Make immobilization devices for you, if needed.
Immobilization devices are used to help you stay very still during your radiation therapy treatments. Patients receiving treatment to the head, neck or brain often have an immobilization device made during the simulation appointment.
- Give you contrast medium, if needed.
Contrast medium (usually simply called “contrast”) may be used during your CT simulation appointment to help your radiation team see your internal organs. Contrast can be given as a drink or as an injection.
- Give you small tattoos to help position you for your treatments, if needed.
Tattoos are used to help the radiation therapists make sure you are in the right position for treatments each time you visit. The tattoo is a small, permanent dot of ink that is injected just under your skin. It will not wash off. Usually you will need only 3 to 5 tiny tattoo dots.
Your radiation oncologist may recommend additional simulation imaging using MRI or PET. If your radiation oncologist recommends this, we will do the MRI or PET simulation on the same day as the CT simulation.
At the end of your CT simulation appointment we will give you a green appointment card. Bring this card each time you come to the hospital for a radiation treatment appointment.
The Patient Flow Coordinator will call you at home after the CT simulation to give you your first radiation therapy treatment appointment and tell you which unit to go to for treatment. Write the date and time of this appointment on the green appointment card. The first radiation therapy treatment appointment is usually booked within a week of your simulation appointment.
Treatment planning is done by your radiation team after your CT simulation appointment. Using the information gathered from the simulation, your team works together behind the scenes to design your personalized treatment plan.
Your treatment plan includes:
- The number and types of beams needed to treat the area
- The number of radiation treatments you will need
- The amount of radiation you will receive at each treatment appointment
Treatments plans are different for each person. Some treatment plans are given in only 1 day and others may be given over several weeks. On average, radiation treatments are given daily for 4 to 5 weeks.
Treatments are given Monday to Friday between 8:00 AM and 6:00 PM.
If a statutory holiday occurs during your treatment, your schedule will be adjusted so that you still get the right number of treatments.
When you arrive:
Check in at the reception desk on level 1B or 2B of Princess Margaret Cancer Centre.
units 1 to 18 go to
unit 19 go to
The Patient Flow Coordinator will show you how to swipe your green appointment card and will check you in. Your first treatment session will usually last about 30 minutes. Your other treatment sessions will last about 15 to 20 minutes.
During Your Treatment:
When it is time for your treatment, the radiation therapists will position you on the treatment bed. Once you are positioned, the bed will be moved under the linear accelerator (the radiation machine). The therapists will check measurements and take images to make sure you are in the right position each day.
The radiation therapists will not stay in the treatment room with you during treatment. The radiation therapists can see you through a camera while you are receiving treatment and will make sure you’re okay. There is an intercom in the room that you can use to speak to the radiation therapists whenever you need to.
The linear accelerator will not touch you during the treatment sessions. It may move around your body during the sessions to give you radiation from different angles.
Radiation treatment doesn’t hurt. You will not see or feel anything during the treatment. You may hear clicking or whirring noises from the machine. These noises are perfectly normal. Radiation treatment does not make you radioactive.
When the radiation treatment is finished, the radiation therapists will come back into the treatment room. They will remove any immobilization devices and help you off the bed. They will also be able to help you with any side effects you may be having.
Each radiation treatment room has a CD player for music. You are welcome to bring in your own music to listen to while you have your treatment.
Your radiation therapist will give you a schedule for your radiation therapy treatment appointments each week. The therapist will review the schedule with you. You can also see your UHN appointments by logging in to myUHN Patient Portal.
Learn more about myUHN Patient Portal »
Your review appointment is a weekly visit with your radiation oncologist and oncology nurse to review how your treatment is going and to take care of any side effects you may have. It is important to ask questions and to tell your doctor how you are feeling during this appointment. You may want to talk about:
- Any questions or concerns you have about your treatment
- Whether you have felt any changes since starting treatment
- Symptoms or side effects you may be experiencing
- Prescription renewals
- How you are coping with treatment
- Whether you have any difficulties getting to your appointments
- Whether you have any financial difficulties paying for your medications or other supplies
Before each review appointment, a volunteer will help you fill out the DART self-assessment form. DART stands for Distress Assessment and Response Tool. DART asks about your experiences with common physical symptoms, practical concerns and emotional concerns. Your health care team uses your answers to track how you are doing and to make sure your most important concerns are looked after.
Learn more about DART »
Your review appointment will be on the weekly schedule that your radiation therapist gives you. Your review appointment could be on level 1B, level 2B or in your clinic. When you arrive, check in at the reception desk on level 1B, level 2B or in your clinic.
Review appointments usually take about 20 minutes.
We do our best to stay on time. Unfortunately, your appointment may be delayed by unforeseen circumstances. We recommend that you come prepared for delays. For example, make sure that your arrangements for things like babysitting, elder care and parking can accommodate a longer than expected appointment.
- The Princess Margaret has a free child-care service called The Magic Castle. The Magic Castle takes care of children up to 12 years old while their parent or guardian goes to an appointment at Princess Margaret.
Find out more about the Magic Castle »
During the last week of your radiation therapy treatment, you will receive a follow-up appointment to come back and see your radiation oncologist. The follow-up appointment usually takes place 4 to 8 weeks after you finish your treatment.