Radiation in a Nutshell

Love heals.
So does radiation.

The type of radiation I'm receiving is external-beam radiation delivered in the form of photon beams. My radiation plan consists of 25 "daily" (weekday) appointments. I will receive a total of 5,000 centigray (cGy) during the course of this treatment. This cumulative dosage is a lifetime maximum; no more radiation in the same quadrant on my body after this stint.

Although my total dosage of radiation is 5,000 cGy, it is divided into 25 treatments =

200 cGy daily via two planes of radiation to my chest wall and breast skin + 2cm of skin all the way around my breast

-AND-
180 cGy daily via straight-on radiation at my neck lymph nodes

Each day I go in, get dressed in my smock, and wait for one of the technicians to invite me in. I walk through a doorway (the door is about 6" thick!) and into the radiation room. Here's a view of the room at that point:

The room is a cool temperature because of the machinery's needs. I take my smock off and lay down on the table, putting my arms up in the arm rests. I usually opt to have a warm blanket placed on my stomach/legs to feel more comfortable.

The frying pan.

It is important for my body to be in the exact same position as it was during the simulation, so all the planes of radiation are hitting exactly where it was planned to go. (Don't want to overshoot things and accidentally nuke my entire lung or anything!) How do they do this? Using tattoos! Yes, I received 4 tattoos (they look like black freckles): one on my left side, one on my right side, one in the middle of my chest (between my boobs), and another just outside of my right-side armpit.

Using fixed laser beams, they align my body to the beams and move the table to my "special" position: 97.7 on the dial. Then we're good to get started. My radiation treatment is a three step process:

1. Receive plane of radiation from upper left side: aimed at my chest wall and breast.
2. Receive plane of radiation from lower right side: aimed at my chest wall and breast.
3. Receive rectangle of radiation from directly in front: aimed at my neck lymph nodes.

Of the 25 treatments, 12 include this weird stuff called bolus. The best way I can describe it is: same feel as GelGems (those decorative sticky things you slap onto windows for decoration), but double the thickness. I have my own special cut sheet of bolus. It is used to "trick" the radiation into thinking the bolus is my skin; in a way, it forces the beam concentration to be on the breast skin (not penetrating further). The bolus is used for the first two steps in my radiation treatment. It is not used for the neck lymph node treatments. Since the bolus concentrates the radiation at my skin surface, my skin reacts by getting red a few days after those treatments.

A bolus day.

If you are still reading, you're a tropper and a curious human being. Hang with me - I think this stuff is fascinating.

With the beams of radiation, how do they "miss" my right lung and spinal column? By these neat things called multileaf collimators (MLCs). You can see them in the picture below - the top set of MLCs is mostly closed (with an open line down the middle), the bottom set is a trapezoid. These MLCs are customized for each patient. My plan, when loaded up into the machinery software, is set to block out as much radiation as possible to my lungs, spinal cord, etc. for each plane of radiation.

MLCs in machine.

There is a "step-and-move" done with the MLCs. Basically, the MLCs move while the radiation is administered. The MLCs not only block out other parts of my body that we don't want radiated, but they also focus radiation onto my chest wall by being open at first, then closing to block out most of the breast skin. Although they've blocked out the majority of my spine and lung from being radiated, there will still be some exposure. They want to be sure to get the entire chest wall and breast skin area - so compromises must be made. I may have some scar tissue on my lungs, but that will only show up in x-rays and should not change my lung capacity or breathing.

And that, dear readers, is radiation in a nutshell!