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This supervision concerns the technical conditions of irradiation, its tolerance and its efficiency as judged by physicians.

Supervision of the technical conditions of irradiation

• The correct functioning of irradiation generators is the work of medical physicists and electronic engineers who work within the radiotherapy unit.

• § The control of treatment duration and dose delivered for each fraction is ensured by the computer system linked to the accelerator.

• The good positioning of the patient and the beam is verified by the radiotherapist at the first treatment session using specific radiographic images (gammagraphies) or the portal imaging system.
  
• During the various treatment sessions, the technician plays a major role in repeating the radiotherapist’s explanations in order, to accurately install the patient according to the therapeutic planning, and to reassure him/her during installation and just before leaving the treatment room for the control visual display room in order to begin treatment.

Clinical supervision

Patient supervision throughout radiotherapy treatment is part the radiotherapist’s job, together with the prescription of necessary adjuvant treatment:

• At the first consultation, at the beginning of treatment, the treatment modalities should be fully explained to the patient as well as the most frequently observed side-effects. Anxiety and depression should be considered and treated, hospitalisation should be envisaged in case of poor tolerance and advice on diet and hygiene should be given. The patient should be weighed regularly. The tumour should be described with great precision in order to obtain a reference for the appreciation of treatment efficiency.

• The following consultations should be planned every week. Their goal is to appreciate the patient’s general treatment tolerance (weight, general status, haematological toxicity), local tolerance (with prescription of appropriate treatment in the case of acute local reaction). The radiotherapist will also appreciate the tumour regression and discuss with the patient any potential psychological difficulties. If necessary (and in particular for head and neck cancers) dietary follow-up will be set up.

The interruption of irradiation can be necessary in the case of major intolerance.

After completion of radiotherapy, a precise report should detail the doses delivered, the technique used and the tolerance observed and should be sent to the various physicians involved in the patient ‘s treatment and follow-up.