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User
Posted 28 Mar 2018 at 18:45

I am now on my way with the HT course and looking at RT in three months. 

Having explored the  private use of Cyberknife (which although available won't offer any benefits to me personally) I am now looking at treatment through the NHS. I am told that I will get treated by machines that are 'Image Guided, Intensity Modulated' Linear Reactors and offer me the best alternative. Private funding is available but only buys you some TLC and a better waiting room apparently.

My question relates to the use of Fiducial markers on these machines. The Oncologist in charge of my case mentioned that these will not be fitted and that was confirmed by the RT department where I would be attending. Is that normal? I was under the impression that they were required for all current RT and that fitting them ensured the highest accuracy of beaming and the reduction of side effects. That said, I have one core near the periphery of the capsule so some spread to mop up anything outside is required I presume.

I don't know if the markers won't be fitted because the machines are good enough not to need them or whether I am looking at a cost saving measure that might cost me dear during and after treatment.

Anyone with any thoughts on this? 

User
Posted 28 Mar 2018 at 19:54

Not all hospitals use fiducial markers and not all oncologists use them for all patients. The important thing is to confirm that it is IG-IMRT that you will be having.

Our onco uses gold markers for some IMRT but did not in John's case, possibly because he was going for a wider area plus the bottom of the bladder. In addition, J was having (as part of what was a trial then) 20 fractions at 3.2Gy rather than the normal 37 fractions at 2Gy so perhaps that made a difference. Either way, he had no side effects to speak of so the lack of markers doesn't seem to have increased the risk of SEs or reduced the effectiveness of the treatment so far.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 28 Mar 2018 at 20:29

Hi David,

I had IG-IMRT last summer. No need for the markers, a CT scanner is part of the RT machine head to check the exact body position at the start of each session and the table is moved to line you up exactly each time.

When you get on the table your body is aligned by lasers and the tattoo markers that they give you at the planning session. The internal organs can get slightly displaced by gas etc. which is why they use the Image Guidance as above.

Bladder filling / bowel emptying was a bit of a pain, but try to get into a routine, and watch what you eat to avoid gas. Had to empty a bit / fill the bladder a couple of times and release a bit of gas.

I had a bit of diarrhoea but was given meds for this and a bit of minor skin soreness on the belt line.

The radiation team at Charing Cross were absolutely brilliant.

I had 20 sessions, regulo 8, totalling 60 gray. I think it was 6 blasts at about 30 seconds each, with the radiation head rotating around me to the different positions.

Edited by member 29 Mar 2018 at 09:03  | Reason: Not specified

User
Posted 29 Mar 2018 at 02:14

If IGRT is being given that is good as not many hospitals have these linacs yet.

Barry
User
Posted 04 Apr 2018 at 21:20

Have you had the initial mri scan with the given tattoo markers that they give you yet? They were my first tattoos ;-)

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User
Posted 28 Mar 2018 at 19:54

Not all hospitals use fiducial markers and not all oncologists use them for all patients. The important thing is to confirm that it is IG-IMRT that you will be having.

Our onco uses gold markers for some IMRT but did not in John's case, possibly because he was going for a wider area plus the bottom of the bladder. In addition, J was having (as part of what was a trial then) 20 fractions at 3.2Gy rather than the normal 37 fractions at 2Gy so perhaps that made a difference. Either way, he had no side effects to speak of so the lack of markers doesn't seem to have increased the risk of SEs or reduced the effectiveness of the treatment so far.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 28 Mar 2018 at 20:29

Hi David,

I had IG-IMRT last summer. No need for the markers, a CT scanner is part of the RT machine head to check the exact body position at the start of each session and the table is moved to line you up exactly each time.

When you get on the table your body is aligned by lasers and the tattoo markers that they give you at the planning session. The internal organs can get slightly displaced by gas etc. which is why they use the Image Guidance as above.

Bladder filling / bowel emptying was a bit of a pain, but try to get into a routine, and watch what you eat to avoid gas. Had to empty a bit / fill the bladder a couple of times and release a bit of gas.

I had a bit of diarrhoea but was given meds for this and a bit of minor skin soreness on the belt line.

The radiation team at Charing Cross were absolutely brilliant.

I had 20 sessions, regulo 8, totalling 60 gray. I think it was 6 blasts at about 30 seconds each, with the radiation head rotating around me to the different positions.

Edited by member 29 Mar 2018 at 09:03  | Reason: Not specified

User
Posted 29 Mar 2018 at 02:14

If IGRT is being given that is good as not many hospitals have these linacs yet.

Barry
User
Posted 29 Mar 2018 at 08:21

Thanks everyone. At least it's nice to know that I won't have to have anything else stuck up me before completing my treatment. 

I was referring to the machines available at Christie's main centre in Manchester. Their web site says they are state of the art so from your replies I guess that's the case and I'll look forward to receiving their no doubt excellent care in the summer.

User
Posted 04 Apr 2018 at 21:20

Have you had the initial mri scan with the given tattoo markers that they give you yet? They were my first tattoos ;-)

User
Posted 04 Apr 2018 at 22:07

Originally Posted by: Online Community Member

Have you had the initial mri scan with the given tattoo markers that they give you yet? They were my first tattoos ;-)

Me too.  I got an anchor each side and a mermaid in the middle. You have to look close tho'.

User
Posted 05 Apr 2018 at 13:59
“Me too. I got an anchor each side and a mermaid in the middle. You have to look close tho'.”

Get you!

I got three dots you can hardly see. No artwork!

Ian

Ido4

User
Posted 05 Apr 2018 at 23:46

Ah, you have got the artwork !

 
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