Step 1. Preparation at the university hospital’s clinic

For this reason, proton beam therapy is especially suited to the treatment of certain types of disease, and for certain patients; for example, tumours located close to vital organs such as the brain and lungs or in the abdominal cavity. One such large patient group is children and young people, as it is always desirable to provide them with the gentlest treatment possible.

Initial appointment
At your initial appointment with the doctor, you will be given information about proton beam therapy, as well as the preparations that you need to make prior to treatment. You will also receive practical information about things such as travel, meals and accommodation during your treatment period. As county councils and regions have varying regulations regarding remuneration, you will need to know what applies to your specific case.

Making a fixation
In order to help you remain in the correct position during treatment, a fixation may need to be produced that will be attached to the treatment table. A mask may be used if, for example, your head is to be treated. If you are to receive treatment in the abdominal region, then cushions moulded precisely to your body will be used. Fixations are produced at the university hospital and are then dispatched to the Skandion Clinic prior to your treatment.

Computed tomography (CT) scanning
Another part of preparations at the university hospital is an imaging procedure that uses x-ray equipment; this is called computed tomography or CT scanning. If you are in pain, it is a good idea to take painkillers prior to the examination as this may make it easier for you to remain still. Please speak to the nurses if you feel that you may require further pain relief.

Prior to the examination, the nurse may mark the skin of certain patients with small dots. These marks are used later during radiation therapy to identify the exact spots as on the CT image.

Target definition and treatment plan
In the next stage of preparation, your doctor will decide which areas are to be treated and how much radiation is to be given. This defines the targets for the proton beams. Specialist nurses and medical physicists are responsible for planning how these areas are to be irradiated in order to achieve the best results. This planning phase may take up to two weeks.

Handover to the Skandion Clinic
Once the dose distribution plan is completed and approved, all data will be forwarded to the Skandion Clinic and we will begin our own preparation process. If you are to use a fixation as a positional aid, this will also be sent to the clinic.

You will receive an appointment letter through the post in good time prior to your treatment. This will include the date of your first visit to the Skandion Clinic.

Initial information
A couple of days before or, in certain cases, on the same day as you begin your treatment, you will have a meeting with the oncology nurse who will be responsible for you during your treatment. Please feel free to take a family member or friend with you.

You will be taken to a separate room and the nurse will go through your treatment schedule etc. During this conversation, you will receive further information about how your treatment will be performed. If you have any questions, you will be able to ask them at this meeting.

CT scan
After your initial meeting with your primary nurse, you will be examined using computed tomography, an imaging procedure that uses x-ray equipment. We do that to check that we are fully prepared for your treatment, that the treatment plan appears to be in order and that any fixation prepared for you fits correctly.

In the vast majority of cases, you will receive your first treatment one or two days after your first visit, although in certain cases treatment may begin on the same day.

On each day of treatment, you will report to the reception desk in the Skandion Clinic waiting area. At the desk they will informe you of any changes to your treatment schedule or if your treatment has been delayed. When the time comes for your treatment, a nurse will come to pick you up. If you need to change the nurse will show you to a changing room. You will then be asked to lie down on the treatment table, with the fixation on if you are using one. There are always at least two oncology nurses present at every treatment.

Positioning
In order to make sure you are lying correctly during your treatment, we use a positioning laser adjusted to the marks on your skin or the fixation made at the local hospital. You may have further marks plotted on your skin to assist in positioning and adjusting the proton beam. It is important that you allow these marks to remain in place throughout your treatment.

Please bear in mind that the dye used for marking may stain your clothing.

Scanning
Before we begin the treatment, we will check that you are lying in the correct position. This procedure is repeated before every treatment. While scanning is taking place, the nurses will go out to the adjacent control room, although they are always able to see and hear you in the treatment room with the aid of surveillance monitors and speakers. Only the patient is permitted in the treatment during scanning and treatment.

Treatment
After scanning has been completed, it is time to begin your treatment. This may be implemented from one or more angles, and the equipment may make sounds when adjusting position. It is important that you lie completely still, so try to relax as much as possible.

The irradiation itself takes only a couple of minutes and you will not see or feel anything. You have an alarm button in your hand throughout the treatment and it is possible to interrupt treatment if, for example, you begin to cough.