Just finished week two of my salvage radiation treatment. Once per week, I meet with one of the doctors on the oncology team -- first week was a resident, and this week it was the senior oncologist. So I being curious, I asked them about full bladder vs empty bladder and the different experiences from Dave and Andy. The senior oncologist gave the fullest answer:
* Both said the main advantage of empty bladder is ease, and consistency. It's easy to have consistent positioning of internals with bladder is always empty.
* The senior oncologist said the physicist at the hospital worked with the manufacturers in designing the machines, and he is very keen on full bladder to push the bladder and small intestine as far away as possible.
* At my center, they image, look at images, and then adjust before treatment for every session, so variations in bladder fullness can be taken into account.
* the senior oncologist was aware that protocols may be different elsewhere (as he has heard from foreign doctors who trained here). He says some centers may prefer empty bladder protocol for ease, and because they may not scan every time, or look at the pictures before every session. I asked why some centers may use full bladder for most, and empty for some (what Andy saw), and he said that the ones using empty bladder may have trouble achieving consistency with full bladder, so they choose empty bladder for these patients to ensure consistency.
For comparison the protocol at my center (Princess Margaret -- top cancer center in Canada) is as follows:
1. You are given a barcode scanner, and you simply scan in when you arrive, so staff know you are there.
2. You have instructions on how much to drink. I'm very well hydrated, so if I drink one hour before, my bladder is too full. So I'm drinking 20-25 minutes before.
3. First thing in the session is the two radiation technicians adjust your body to line-up the three tattoos.
4. Next, the machine does an imaging scan to see where everything is positioned internally.
5. The technicians look at the pictures, and input information into the computer.
6. The machine then make very small micro adjustments to the platform you are on to get the position just right based on how you are looking at the time.
7. Then the radiation is give (maybe one minute total time).
Very precise, but can cause delays and scheduling issues. Once I was taken into my appointment early because the fellow ahead of me (it was just his 2nd session) was too full and went to washroom and let out too much. So he had to drink again and wait. Another time, the person ahead of me was late, so they took me early as they knew I tend to be very well hydrated and could go early. But full bladder can cause delays due to things like that.