Tag Archive | CT scan

Radiation simulation

After I picked up my lymphedema sleeves, it was off to the Cancer Center for the first step for radiation treatment – the simulation. I needed a CT scan of my body (called a simulation) so the radiologist (Dr. Figura) can develop a radiation setup that is specific to my morphology.

I like CTs much more than MRIs because they’re quiet and I didn’t even need an injection for this one. I had a choice of a couple of gown patterns and saw a new one:photo(11)

Not too bad, compared to many of the others I’ve had. Once I was gowned up, I went into the CT room. The tech had me lie down on the table, with my head resting on a flat, not-so-comfortable cushion and my arm held over my head. She added a wire sticker on my mastectomy scar so the scar’s location would show up on the scan. There was a series of lasers shining down from the ceiling that I was lined up with and sent into the CT. Five minutes later, I slid out of the CT machine, easy enough.

Even when the CT was over, I wasn’t quite done. The tech asked me to lie still on the table while she marked the laser lines on my body with blue Sharpie. Dr. Figura also came in and drew a series of marks on and around my scar. The plan is to get 28 treatments on my chest, and then five extra concentrated around the mastectomy scar. The tech had to transfer the Sharpie marks from my inflated breast onto tracing paper. At least she didn’t have to worry about the tissue squishing around while she drew since there’s no give on the expander at this point.

I got some special clear stickers placed over the marks on my chest and told to be very careful not to wash or pick them off. If it looks like any are going to come off, I have to go back to get the sticker replaced. Needless to say, I’ve been careful with them so far.

Notice some of the radiation guide marks.

Notice some of the radiation guide marks.

By the time I got off the table, my arm was killing me. My armpit didn’t really appreciate stretching like that, but the worst was the cramping in my shoulder muscles. I was told I’ll have one more marking session (with the opportunity to exchange the Sharpie/sticker combo for tiny tattoos) that will last a half an hour. The tech recommended some Tylenol to help with the pain, but I might use one of the Valium I have left instead.

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Tests to clear up the previous tests

One more round of tests before the chemo starts. I needed an abdominal CT scan with contrast and a vaginal ultrasound to check on the abnormalities the PET scan found. I would also need a baseline MUGA test.

ba56The CT scan required a 6-hour fast, so I got up at 5:45 for a quick breakfast, and went back to bed. There was no way I’d make it to noon without some food in my stomach, and I really didn’t want to start my day that early. Turns out the fasting was to allow the barium contrast in my gastrointestinal tract to show up most strongly. I had to drink 900 mL of barium sulfate in about a half an hour. I got berry flavor, which wasn’t actually too bad. The worst was the slightly thick texture of the drink which made me gag occasionally, but I managed to get it all down. Once I finished the barium, it was time to get into the CT scanner – just another table that slides through a tube. I also needed IV iodine to add contrast to the blood vessels. Since I have a PowerPort, they actually got to use my port for the first time – yeah! Nurse said I had good blood return, so the port was working well. 153The iodine injection caused the weirdest sensations. It made the inside of my ears feel hot, and made me feel like I was peeing, although I wasn’t. It only lasted a minute or two, but it was quite odd. The CT scan was quiet, but I did have to hold my breath a couple of times. The nice thing was there was a counter on the machine that told me how many seconds longer I would have to hold my breath, so I wasn’t wondering how much longer every time.

Elements added: Barium and Iodine

The ultrasound to look at my ovaries was the easiest test yet, since there were no injections needed. I just had to drink a lot of water before getting there so I had a full bladder for the first half of the test. I did get to empty the bladder before the tech did the intravaginal part of the test. Once again, I got talking to the tech, and she showed me the ovaries and where the developing eggs were on the ovaries.

The final test of the week was a MUGA scan (or Multi-Gated Acquisition scan). Because my tumor is HER2 positive, Dr. Li is adding Herceptin to my drug regimen. One of the less common (2-4% chance) side effects in heart failure, which would definitely count as a bad thing. So, as a precaution, everyone on Herceptin has periodic tests of their heart to make sure it’s fine. There’s a lot of natural variation in heart efficiency, though, so you need a baseline test to compare with future tests.

A MUGA scan uses radionucleotides, specifically tc43technetium, attached to your red blood cells to get a picture of how efficiently your ventricles contract. Technetium will attach to different cells in your body, depending on what loading medication they give you. I got the loading medication (a sn50tin-based solution), and then sat in a waiting room while it moved throughout my bloodstream. After about 20 minutes, I got the technetium injection, and then moved to the machine to measure my heart function. There, I laid under a set of white plates for eight minutes and was done. Since I had been talking quite a bit with the tech (are you sensing a theme here?), he called me over and showed me the pictures the machine took. It was pretty awesome seeing the blood move through the heart, and the walls of the heart moving. The scan is set up to compare the ratio of the left ventricle at minimum and maximum contraction. Once again, I was radioactive for the day, and a bit longer than the PET scan since the technetium has a half-life of six hours.

Elements added: Technetium and Tin

CT results showed the mass on my kidney was a cyst (yeah – not renal cancer!) and there’s a cyst on the ovaries. Ultrasound was inconclusive – there’s a mass on an ovary, but it wasn’t clear with it is exactly (probably the cyst seen on the CT). MUGA showed good heart functions to start with. All set to start chemo now!