You are now ready to get treatments underway. It is imperative that we have everything exactly how it was at the time of your planning CT scan as this is what your treatment plan is based on. Every patient is different, and no two people will have the exact same treatment or set up.

Daily Treatment Preparation

Prior to your V-Sim, you will receive information about daily treatment preparation. For prostate patients, generally you will receive instruction for water consumption prior to daily treatment. For anesthesia patients, you will be given eating/drinking guidelines based on your case.

For all patients, we ask that you arrive on time for your appointment, follow all pre-treatment guidelines, and try to avoid eating heavy meals before treatment.

A Typical Treatment

While some of the therapy staff members are preparing the treatment room for your arrival, another will escort you to a gowning room (if needed) or directly to the treatment room. We will assist you onto the treatment table, and prepare you for treatment. 

Because of the precise delivery of the proton beam, it is imperative that patients are immobilized prior to treatment.

• Pediatric patients under the age of six are anesthetized prior to treatment.
• Patients treated for head or neck conditions will be immobilized with their custom mold and mask.
• Patients treated for prostate cancer are placed into their body molds, and a rectal balloon will be inserted (similar to the process at your original CT scan). The rectal balloon pushes the rectal wall down and pushes the bladder up, thus supporting the prostate in position to reduce movement. This process helps us reduce the dose to surrounding organs.

Once immobilized, a robotic arm will guide the table into treatment position. You will be handed a “call button” to alert the staff in the event you need anything during the treatment process. X-ray panels are extended and a series of X-rays are done to check alignment. If needed, a series of minor table movements are made to adjust positioning. Another series of X-rays may be done to verify the movement into the proper position and accomplish our treatment tolerance of within 2mm.

When the radiation therapists are satisfied with your positioning, a physician will verify the alignment and give approval for treatment. A physician will verify every treatment field before the proton beam is delivered. 

Indiana University Health Proton Therapy Center uses a bar code scanner to verify the molds and beam-shaping devices as a final verification point before beam delivery. 

Staff members will exit the treatment room before the proton beam is delivered. Video cameras and an intercom system are installed in every treatment room to allow for continuous monitoring while staff members are outside the room. There is typically a one- to two-minute wait for the beam as the cyclotron readies for treatment. Typical exposure (beam on) time is 45 seconds to one minute. Patients do not feel the beam delivered. 

Once the treatment is completed, staff members will return to the treatment room and prepare you for additional treatment fields. If additional fields are treated, we will follow the same procedure (X-rays, table adjustments, physician approval, and beam delivery) for each field. Once all fields have been treated, the staff members will assist you from the treatment room.

Cone Down

Depending on your treatment plan, some patients have a series of “cone down” days. After a certain number of treatments at a prescribed dose, or once some of the tissues inside the initial treatment area have reached a certain dose, we begin to treat a smaller area and/or change the beam’s direction. This allows us to give the area that needs more treatment a higher dose and limit the dose to surrounding critical/normal tissue. 

Your “cone down” is similar to your V-Sim in that we perform a series of checks and measurements. On most occasions, we administer a treatment on the same day. Treatment times are usually 10 to 30 minutes longer for “cone down” day only.

Weekly Status Checks

Our therapy and nursing team members are available at anytime during your treatment to address questions or concerns. Once a week, you will have an appointment with a member of the nursing staff and one of our radiation oncologists for your weekly status check. This appointment gives you an opportunity to discuss how your treatments are proceeding, to denote any changes in your health, and to ask questions about your plan.

General Information About Scheduling

We ask for your understanding and support as we meet the needs of all patients under treatment. While we do our best to accommodate everyone’s schedule, there are certain scheduling parameters. Every Friday, you will be given your appointment times for the next week. Because of varying patient needs, treatment times can change from day to day.

• Treatments are generally scheduled from 7:00 a.m. to 10:00 p.m., Monday through Friday, and are based on patient volume.
• Pediatric anesthesia appointments are always scheduled for the early morning. Because these patients need to go without food or water before treatment, it is essential to give them priority.
• Patients with other physician appointments, surgeries, or are receiving chemotherapy while under treatment, will receive high priority in requesting specific appointment time.
• If you are working, commuting, or have special transportation needs for treatments, we will do our best to adjust your schedule to accommodate your needs.
• There are few occasions in which we will treat patients on weekends due to holidays and scheduled maintenance days.
• Unfortunately there are occasions of mechanical failure or other treatment delays that cause us to get behind on the schedule. Every effort will be made to contact you and reschedule your treatment time to lessen wait time at our facility.
• With the majority of our patients coming from out of town, we have multiple requests for “early Friday/late Monday” appointments to accommodate weekend travel. Because of anesthesia, surgeries, and chemotherapy appointments, we cannot accommodate every request.

Making Your Indiana University Health Proton Therapy Center Experience Enjoyable

• We provide a wide variety of music to listen to during your treatment. Each treatment room is equipped with CD players and MP3/iPod docking stations. If we do not have your preferred music selection, you may bring in your own CDs or MP3/iPod.
• You will be instructed at your planning CT scan/mold appointment as to what clothing to wear for your treatment. For those patients that have a treatment mask, we typically suggest a “no collar” shirt so that it does not bunch up and affect the mask position. For prostate patients, you will need to wear a gown provided by us.
• On Fridays, pediatric patients are invited to select a toy or gift card from the Pediatric Treasure Shelf.
• There are always activities to enjoy during your stay in Bloomington. A calendar is available to showcase community and Indiana University Health Proton Therapy Center events.

Last Treatment Day

Expect to see a radiation oncologist within one or two days of your final treatment. They will give you specific instructions for post treatment care. Your last treatment day is a time for celebration. We offer special last treatment day celebrations for our pediatric patients.

Follow-Up Appointments

Our physicians would like you to return to Indiana University Health Proton Therapy Center for at least one follow-up appointment. This gives you the opportunity to discuss any concerns that you may have post treatment. If there are any treatment-related side effects, our physicians can monitor progress and ensure that any issues are addressed. It also gives us the opportunity to prescribe further baseline tests to monitor your condition. 

If you so choose, our physicians can send monitoring recommendations to your local physician. Most of our patients enjoy returning to Bloomington for follow up to see staff members and to reunite with friends in their home away from home.