This is how proton radiation works

Step-by-step: How the treatment works

Step 1. Preparations at the university hospital

To receive proton beam therapy at Skandionkliniken in Uppsala, a referral from an oncology clinic at one of Sweden’s seven university hospitals is required. If you are a patient at a county hospital and your doctor thinks proton therapy might be an option for you, he or she will send a referral to your designated university hospital. You will then be contacted by the university hospital, and all preparations for proton therapy will take place there.

Admission visit

At your first appointment with the doctor, you will receive information about proton beam therapy and the preparations needed before your treatment. You will also get practical details about things like travel, accommodation, and meals during your treatment period. Since the regions have different rules regarding financial reimbursement, it is important that you find out what applies to your particular situation.

Production of fixation devices

To help you stay in the correct position during treatment, fixation devices (positioning aids) may be required. These are attached to the treatment table. For head irradiation, for example, a mask is used. For abdominal irradiation, cushions molded to your body may be used. The fixation device is made at the university hospital and then sent to Skandionkliniken before your treatment begins.

Computed tomography, CT scan

Another part of the preparations at the university hospital is a scan called a CT (computed tomography). If you are in pain, it is a good idea to take your pain relief medication before the scan, as it will make it easier to remain still. Talk to the staff if you think you need additional pain relief.

Before the scan, some patients will need to have small marks made—tiny tattoo dots on the skin. These are used later in the radiotherapy to ensure the staff can position you in exactly the same way as during the scan.

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Target drawing and dose planning

The next step in the preparations is for your doctor to determine the area to be treated and the amount of radiation to be delivered. “Target” refers to the specific area where the proton therapy will be given. Specialist nurses and medical physicists then plan how to deliver radiation to this area to achieve the best possible result.

Handover to Skandionkliniken

When the dose plan has been completed and approved, all information is sent to Skandionkliniken and our preparation process begins. If you will be using a fixation device (positioning aid), it will also be sent to the clinic.

Step 2: Preparation at Skandionkliniken

Before the start of your treatment, you will receive an appointment notice via 1177.se. If you have chosen not to receive digital notices, the notice will be sent by post. The notice includes the dates for your first visits to Skandionkliniken.

Arrival interview

A day or two before, or in some cases on the same day as your treatment starts, you will have a meeting with the oncology nurse responsible for you during your treatment period. You are welcome to bring a family member or friend.

You will sit together in a private room and go through your treatment schedule, times, and other details. During this meeting, you will learn more about how your treatment will proceed. If you have any questions or concerns, you can raise them during this appointment.

CT scan check

After the arrival interview, you will have a CT scan (a type of X-ray) to make sure that everything is as planned before your treatment starts, such as ensuring that any fixation devices or positioning aids fit correctly.

In most cases, you will receive your first treatment one or two days after this initial visit. In some cases, the treatment may start the same day.

Step 3. Treatment begins

Each day when you come for treatment, you check in at the reception in the entrance hall at Skandionkliniken. There you will be informed if there have been any changes to your treatment schedule or if your treatment is delayed. When it is time for your treatment, a nurse will come and get you. If you need to change clothes, the nurse will show you to a changing room. You will then lie down on the treatment table and in your fixation device, if you are using one. There are always at least two oncology nurses present at each treatment session.

Positioning

To ensure you are in the correct position during treatment, we use positioning lasers and surface scanning systems. The laser is aligned with the marks made on your skin or fixation device at your referring hospital. You may receive additional marks drawn on your skin to help us accurately position you and set the treatment field. Please make sure these marks stay in place throughout your treatment period. Be careful when showering! Remember that the marking ink may stain your clothes, so it’s best to wear older or dark-colored clothing next to the treated part of your body.

Imaging

Before each treatment, we use imaging to ensure you are in the correct position. This is done before every treatment session. During the imaging process, the nurses step out into a control room just outside the treatment room, but they can see and hear you at all times via cameras and speakers. During both imaging and treatment, only the patient is allowed in the treatment room..

Treatment

After imaging, it is time for your treatment. The radiation may be delivered from one or several angles, and you may hear the machine making noise as it moves into position. It is important to remain completely still—try to relax as much as possible. The actual irradiation only takes a few minutes and you will not feel or see anything during the treatment. You will have an alarm button in your hand throughout, and it is possible to stop the treatment if, for example, you need to cough.

For patients

The treatment