Radiotherapy

Radiotherapy is the use of precise doses of high energy x-rays and other types of radiation to treat cancer. The radiation does not stay in your body and it is safe for you to mix with children and adults.

It is a painless treatment, similar to having an x-ray taken. It should take between 20 minutes and one hour to deliver. Radiotherapy is not routinely given on Saturdays and Sundays.

Radiotherapy can cure some cancers and also reduce the chance of a cancer coming back after surgery. It may be used to control a cancer or help improve the symptoms of it.

There are two types of radiotherapy treatment:

  • external beam – given outside the body
  • brachytherapy – given inside the body (only available at the Northern Ireland Cancer Centre)

Your oncology doctor or clinical site specialist radiographer (CSSR) will discuss these with you and decide which type of radiotherapy will be most suitable for you.

By carefully planning your individual radiotherapy treatment, we can reduce the dose received by the healthy tissue and organs around the area you are having treated. It also reduces the risk of possible side effects.

The area of your body being treated and number of treatments will depend on:

  • your specific type of cancer and its position in your body
  • any other treatment you have had

  • Side effects

    Your oncology doctor or clinical site specialist radiographer (CSSR) will discuss any possible early or late side effects with you before the start of your treatment. These will be clearly documented on your consent form.

    The side effects you may experience will depend on the part of your body being treated and how much treatment you have. Side effects only affect the area of the body being treated.

    Everyone’s experience is different. Most people develop side effects approximately two weeks after treatment starts, while others experience very few side effects.

    We will give you support and advice about managing side effects or reactions to treatment. We may also refer you to other health professionals.

    Longer-term side effects are rare. They can develop months or even years after treatment has finished. Your doctor or CSSR will discuss this with you. Please let us know if you have any concerns.

    Hair loss

    With radiotherapy, hair loss only occurs in the area being treated.

    If your radiotherapy treatment results in hair loss, we will refer you for a consultation with a cosmetician (hairdresser). The cosmetician can supply patients with a wig from a selected range of styles free of charge. Information on this is available from your radiographers.

    For further information about wig fitting services for Belfast Trust cancer patients, please contact the wig fitting team using the details below:

    Telephone: 028 9615 0077
    Email: cancer.info@belfasttrust.hscni.net

    Loss of appetite and weight loss

    People can sometimes lose their appetite during radiotherapy treatment, but stress and anxiety may also affect appetite.

    Please tell one of your radiographers or treatment team about any weight loss or loss of appetite you experience. They can refer you to the appropriate services.

  • Managing side effects
    Tiredness (fatigue)

    Daily radiotherapy treatment can make you feel more tired than usual. You may also be recovering from surgery or chemotherapy treatments and these can also cause fatigue. Continue with normal activities if you feel you can, but allow yourself extra time to rest.

    It can help to combine rest with gentle exercise (such as a short walk) drinking plenty of water and eating a healthy diet. Some people are able to continue working, but others may be too tired. Remember, please inform your doctor, radiographer or ward staff about any reactions or side effects you experience.

    Skin

    The skin at the treated area may become pinker or darker, depending on your skin colour. If you are unsure where this is, please ask one of your radiographers to show you.

    Skin treated with radiotherapy may feel dry, tight, sore and / or itchy (like sunburn). You may develop a rash in the treated area, or where the radiation beam exits your body.

    If your skin blisters or peels, please seek further advice from your treatment team. We will provide support and advice to help with any discomfort.

    Some factors may affect how your skin reacts to radiotherapy, for example:

    • the dose of radiation you have been prescribed
    • having radiotherapy on areas of your body where your skin folds (for example groin, buttocks)
    • smoking – this can affect the oxygen levels in your skin and its ability to heal
    • other health conditions such as diabetes or heart disease

     

    As part of your skin care during treatment, you may be referred to the Radiotherapy Nursing Team. If your radiotherapy appointment is after 4pm and you need an appointment with the Radiotherapy Nurses, please inform the reception staff at check-in, as this service is only available until 5pm.

    Looking after your skin during radiotherapy treatment
    • You may find it more comfortable to wear loose-fitting items made of natural fibres, such as cotton or silk, next to your treated skin.
    • When washing or bathing, please make sure the water is not too hot. Wash the treated skin gently with products you would normally use and gently pat dry your skin.
    • Avoid rubbing your treated skin. Please also avoid using make-up, hair dye, perfumes and aftershave on or close to the treated area.
    • If possible, reduce shaving of your treated skin, unless your radiographers have advised otherwise. You should also avoid wax, cream or laser treatments to remove hair from, or close to, the treated area.
    • If your skin is not blistered or peeling, you may go swimming. It is best to shower immediately afterwards to wash off the chlorine and then apply moisturiser. Please stop swimming if it irritates your skin.
    • Please avoid exposure to the sun and protect the treated area from direct sunlight. Continue to protect the treated area from the sun for at least one year after you have finished your radiotherapy treatment. Skin that has been treated by radiotherapy will be more sensitive to the sun. We recommend you use sunscreen with SPF 50.
    • If you do not currently use a moisturiser, speak to one of your radiographers and they will be able to suggest a few options for you.
    • Moisturise your skin frequently, gently smoothing it onto your skin until it has soaked in. This can help reduce any reaction your skin has to the treatment.
    Things to remember
    • Eat well and drink lots of fluids, as advised by your treatment team.
    • Care for the treated area as advised.
    • Do not remove the skin marks defining your treatment area unless advised by the radiographers.
    • Talk to one of your radiographers if you are concerned about anything.
    • Do not compare your treatment with others – it has been tailored to suit you.
    • Do not compare side effects with others – remember your treatment may not be the same and everyone reacts differently.
  • General advice during radiotherapy treatment
    Pregnancy and health conditions

    If you are of childbearing age or capacity, we will ask you to confirm that you are not pregnant and explain the importance of not becoming pregnant while receiving treatment.

    Radiographers have a professional duty and legal responsibility to protect unborn babies, who are at greater risk of harm from radiation.

    If you have health problems, for example diabetes, arthritis or heart trouble, radiotherapy should not affect them in any way. However, if you think you may be pregnant, or if you have a pacemaker or defibrillator fitted, please tell the doctor or radiographer before they take any x-rays or scans or carry out your radiotherapy treatment. If you have any other concerns, please ask us.

    Vaccinations

    We recommend you take any vaccinations offered to you (for example flu, Covid-19) if you are getting a course of radiotherapy. If you are also having or have had chemotherapy, please discuss this with your oncology doctor as they can advise on the best time to get vaccines.

    Rashes

    If you develop a rash or skin irritation outside the area being treated, please contact the radiotherapy department before attending for your planning or treatment appointment(s). This will not delay your treatment.

    Covid-19 precautions

    Along with extra hand hygiene requirements, you may be asked to attend some of your appointments alone and to wear a face covering while you are in the radiotherapy department.

    This will depend on the circumstances at the time of your appointments and will be in line with infection control guidelines.

  • Patient journey video

  • Patient information evenings

    Patient information evenings aim to improve patients’ and carers’ overall radiotherapy experience. They point people towards available help and support, and help reduce anxiety. You can also see the inside of the treatment room.

    The information evenings are supported by Friends of the Cancer Centre and are a team effort involving staff across the full radiotherapy department.

    The information evenings usually take place on the third Tuesday of each month at 7pm and last just over an hour. For more information, please contact the information and support radiographer on 028 9615 6552 or 078 8581 9378, or speak to a member of staff in the Radiotherapy Department.

    These telephone numbers may be directed to a voicemail service, so please leave a message including your name and telephone number and your call will be returned as soon as possible.

    If the information evenings aren’t taking place, the information and support radiographer or a member of your treatment team will discuss any questions or concerns you have.

  • Getting to and from the hospital

    You will be required to provide your own transport to and from the hospital.

    An ambulance can sometimes be provided if you have no transport. Please contact your GP to arrange this for your radiotherapy planning appointment (first appointment).

    If you need transport for the rest of your radiotherapy appointments, staff in the radiotherapy department can arrange this for you. Please let one of the radiographers know as soon as possible if this is required.

    Most people are treated as outpatients. You will be treated as an outpatient if you live within travelling distance and your doctor thinks you are well enough to travel each day. If you have any questions about this, please ask your doctor or a member of your radiotherapy team.

    Please be aware that due to limited capacity, it may not be possible for us to arrange your radiotherapy appointments around other commitments you may have. We apologise for any inconvenience this may cause and appreciate your patience and understanding.

    Sometimes people may be admitted to the ward for part or all of their treatment. If this is necessary, your treatment team will discuss it with you.

    Details about current visiting arrangements at Belfast City Hospital are available here.

    Public transport

    Details on getting to Belfast City Hospital by public transport are available here.

    Car parking

    Radiotherapy or brachytherapy outpatients who travel by car are entitled to free on-site car parking for the duration of their planning and treatment. Please note, this is for outpatients only.

    You will see the car parks marked on this Belfast City Hospital site map, including the Radiotherapy Car Park to the right of the main tower building.

    We will give you a ticket when you attend for your radiotherapy planning appointment and for the duration of your radiotherapy treatment.

    Please remember to ask for your free car parking ticket.

    • If we provide you with a weekly car parking ticket, it is very important that you use this ticket each day to enter as well as exit the car park, otherwise you will not be able to drive out of the car park.
    • If you have any problems exiting the car park, please press the button on the ticket machine at the barrier for assistance.

     

    Full details on car parking at Belfast City Hospital are available here.

  • Key members of the radiotherapy team
    Clinical oncologist

    A doctor trained in the use of radiotherapy and chemotherapy to treat cancer. They are responsible for overall patient care. Clinical oncologists are supported by specialist registrars and associate specialists.

    Therapeutic radiographer

    They are trained to deliver radiotherapy treatment and help patients cope with the daily physical and psychological demands of radiotherapy. They work closely with the clinical oncologist and physicist.

    Clinical site specialist radiographer (CSSR)

    They are responsible for coordinating radiotherapy treatment and managing side effects.

    Review radiographer

    They are responsible for assessing and managing reactions. They liaise closely with the clinical oncologist, clinical site specialist radiographer, treatment radiographers and other healthcare professionals.

    Phlebotomist

    They are trained to draw blood from a patient for clinical or medical testing.

    Information and support radiographer

    They support patients throughout radiotherapy. Patients or their carers can self-refer to this service or be referred by a healthcare professional.

    Student radiographers

    The Cancer Centre is a training centre for therapeutic radiography students, who may be present during planning or treatment. Students will not be responsible for any part of treatment and will always be working under the supervision of fully trained radiographers.

    Physicists

    They are radiation experts who help plan radiotherapy treatment. They also ensure the accuracy of the radiotherapy equipment used in the department.

    Clinical technologists / scientists

    They produce masks and other devices to help with treatment positioning and accuracy, tissue equivalent materials and special shielding as requested by the clinical oncologist.

    Radiotherapy nurses

    They manage wounds and symptoms and liaise with district nursing as required.

    Other members of the team may include:

    • dieticians
    • speech and language therapists
    • physiotherapists
    • occupational therapists
    • social workers
    • palliative medicine team
  • Your radiotherapy journey
    Radiotherapy planning appointment (first attendance)

    This is usually your first appointment with us. It will be in the Radiotherapy Pre-Treatment Assessment Suite. Please check in at the Radiotherapy Reception on the ground floor of the Cancer Centre.

    Asking for your consent

    During your radiotherapy planning appointment, the doctor or CSSR will ask you to sign a consent form. By signing this form, you are confirming that you have been given information about radiotherapy, including its risks and benefits, and that you have given permission for treatment to go ahead.

    We may also ask for a photograph of you for identification purposes. This will only be saved on the computer used for your radiotherapy treatment and viewed by the treatment radiographers.

    Planning process

    You may need to remove some items of clothing depending on the area of your body being treated. Every effort will be made to respect your privacy and the area of your body will be covered up as much as possible.

    It may take two to three hours for your radiotherapy planning appointment and will involve one or both of the following:

    • mould room
    • CT simulator
    Mould room

    Some people may need to wear a special mask during their radiotherapy treatment – for example, people having radiotherapy to their head and / or neck.

    It is usually made from a plastic mesh material.

    If necessary, this mask will be made for you to wear during each visit.

    Mould room patient

    The mask made in the mould room will:

    • enable the radiographers to give your treatment in exactly the correct area every day
    • be marked to guide the radiographers to the correct treatment area
    • support your head and stop it from moving during treatment

     

    Mould room patient and staff

    The process of making the mask will be explained to you in detail by mould room staff.

    As part of the mould preparation process, you may need to attend the department several times before your treatment can start. Ideally, facial hair (moustaches and beards) should be removed before attending the mould room.

    CT simulator

    This machine is a CT scanner specifically designed for planning radiotherapy treatment. If you need any special preparation for this appointment, you will be advised before you attend.

    We may need to give you an oral or injected contrast (dye). This will help us see the area we want to treat more clearly. We will let you know if we need to do this.

    The pictures from the scan will be used to produce an individual plan of your treatment. There will be no results from this scan as it is only used to plan your radiotherapy.

    CT simulator

    To help the radiographers position you in the same way for each treatment, they will also need to take some photographs of you lying in the treatment position.

    During the planning session, the radiographers will draw some marks on your skin with a pen. Permanent reference marks (tattoos) about the size of a pin head will also need to be made.

    These marks will help the radiographers ensure you are in the correct position for treatment every day. If you wear a special mould or mask for your treatment, the marks will be drawn onto this instead of your skin before your scan begins.


    Radiotherapy treatment

    After your planning appointment, a number of weeks may be spent designing your radiotherapy treatment. Sometimes your doctor may make changes to your treatment plan as the treatment goes on. This is normal and your doctor or radiographer will discuss this with you.

    In most cases, radiotherapy staff in the booking office will contact you at a later date (by telephone or letter) with the date and details of your first radiotherapy appointment. You will be given a list of further appointments when you attend for your first day of treatment.

    Attending for treatment

    When you attend your radiotherapy treatment appointments, please check in at the Treatment Suite reception desk. Take the first corridor on the right, through the double doors, after passing the radiotherapy reception on the ground floor of the Cancer Centre.

    Please do not arrive more than 15 minutes before your appointment time, unless you have been advised to do so.

    Space in the main treatment waiting room is limited and reserved for patients only.

    Occasionally delays may occur. Please check the television screens in the waiting areas for any slight delay with the treatment machines. If you have been waiting longer than 30 minutes for your appointment, please inform the reception staff.

    Please note, reception staff do not have access to your specific details and cannot amend appointments.

    Radiographers will meet you at your first treatment appointment and discuss the possible side effects and number of treatments you are having. Each time you visit for treatment, a radiographer will ask you to confirm your identity. This is a legal requirement. They will ask your name, address and date of birth (even though they may know you).

    Starting treatment

    Each day, radiographers will carefully position you on the treatment couch a short distance away from the machine. The positioning often takes longer than the actual treatment (which only takes a few minutes) as it is very important to ensure the radiation beam is accurate.

    Radiotherapy treatment couch

    When the radiographers are satisfied that you are in the correct position, they will leave the room to switch on the treatment machine. A buzzer will sound. Please do not be alarmed. This buzzer indicates that the treatment machine is about to be switched on.

    It is important to stay as still as possible and try to relax during treatment. The radiographers will advise you if there are any other requirements. While the machine is switched on, the radiographers will observe you from outside the room on closed circuit television (CCTV).

    Radiotherapy console area with CCTV

    During treatment

    If you need the radiographers for any reason, just signal to them with your hand or call out. They can hear and speak to you at any time through an intercom. They can stop the treatment and come to you immediately.

    The treatment couch is quite high off the ground. You should not attempt to move or get off it until the radiographer lets you know it is safe to do so.

    Throughout treatment, your progress will be closely monitored. If you are an inpatient, your doctor will see you during the ward round. Outpatients regularly attend review clinics.

    If you have any concerns or find your side effects difficult to manage at any time, please inform your radiographers or ward staff.

    On certain treatment days, you may require other examinations, for example blood tests or x-rays. Please allow extra waiting time for these appointments. We will do our best to provide the dates and times of these appointments in advance.


    After treatment is complete

    On your last day of radiotherapy, you should be given an information leaflet that may be useful to you, your GP and family.

    After you finish treatment, it may take a number of weeks before some of the side effects settle down. You will be given a review appointment in due course. This will allow the doctor to assess how you are after your treatment and how your side effects are settling down.

    Please check your appointment letter very carefully as your appointment may not be at Belfast City Hospital.

    In most cases, your oncology doctor will arrange to see you at regular intervals. However, your surgical team may carry out your reviews.

    The hospital will inform your GP that you have had your radiotherapy treatment.

    If you have any concerns regarding treatment or side effects, contact your key worker. This is usually the CSSR in the radiotherapy department or the clinical nurse specialist at your referring hospital, depending on your treatment site.

    Please ask your oncology doctor or radiographer for these details if you don’t already have them.

    Skin care after radiotherapy treatment

    Continue the skin care routine you have used during treatment for three weeks after treatment has ended. By this time, any reactions caused by treatment should have settled down.

    If you have seen the radiotherapy nurses during treatment because of a skin reaction, they will advise you on how to carry on caring for your skin.

    Tiredness after radiotherapy treatment

    You may find that tiredness (fatigue) can continue for some time after treatment has finished. Allow time to rest, but also combine this with gentle exercise, such as a short walk.

    The bell

    Ringing the bell in the Cancer Centre means one of our patients has reached their ‘end of treatment day’.

    Please feel free to ring the bell, kindly donated by the End of Treatment Bells charity, at the end of your radiotherapy treatment. It is located beside the Treatment Suite reception desk.

    Treatment bell at the Cancer Centre

    This simple bell has a powerful effect on patients, their families and our staff who have been with them on their journey.

    It unites everyone and gives encouragement to those who are at the beginning of their treatment.

    If you wish to take a photograph or video at the bell, please respect the privacy of other patients and staff and do not include them.

  • Useful information
    Radiotherapy Information and Support Service

    This provides a confidential setting for you to discuss:

    • concerns or questions you may have before, during or after your treatment
    • relevant information and support for you, your relatives and carers
    • referral to other professionals or services that may be helpful to you

     

    To get in touch:

    • ask a member of staff to refer you at any time during your treatment
    • contact the information and support radiographer on 028 9615 6552 (includes voicemail facility) or 078 8581 9378
    Toilet facilities in the Radiotherapy Department
    • one either side of the Treatment Suite reception desk
    • one beside the Portering Station
    • two at the back of the radiotherapy reception waiting room
    • seven at the entrance to the radiology corridor (past the main reception in the Cancer Centre)
    Drinking water fountains

    These can be found in all main waiting areas within the radiotherapy department.